Examination HEAD TO TOE

Before the test, the patient must be prepared so that comfort is maintained, for example,
patients are encouraged to urinate beforehand. Keep the patient's privacy by only opening parts
to be checked, and ask your friends to the patient a third when the opposite sex. Tell your patient
about the action to be performed. Set the time as efficiently as possible so that both the patient
and the examiner is not exhausted. Adjust the position of the patient to facilitate inspection.
1. Physical examination head
Objective of the assessment was to determine the head of form and function heads. Assessment
diawalai by inspection and then palpation.
• How inspection and palpation of the head.
1. Set the patient in a sitting or standing position (depending on the patient's condition and the
type of assessment to be performed).
2. If the patient wears glasses, suggested to release it.
3. Inspect, namely by taking into account the symmetry of the face, skull, color and hair
distribution, as well as the scalp. The face is normally symmetrical between right and left.
Facial asymmetry may be an indication of paralysis / paresif seventh nerve. Normal skull shape
is symmetrical with frontal parietal section facing forward and facing backward. Hair
distribution vary widely among individuals, and scalp normally do not have inflammation,
tumors, or scar / sikatriks.
4. Continue with palpation to determine the state of the hair, mass, freezing, tenderness, state
skull and scalp.

a) Physical examination eye

Assessment of completeness and breadth of the eye depending on the information required. The
general objective eye assessment was to determine the shape and function of the eye.
• How To Inspect the eyes
In the eye inspection, parts of the eye that need to be observed is the eyeball, eyelids,
conjunctiva, sclera and pupil.
1. Observe the eyeball against the protrusion, eye movements, visual fields and visual acuity.
2. Observe the eyelids, note the shape and any abnormalities in the following manner.
a. Instruct the patient to look forward.
b. Compare left and right eye.
c. Instruct the patient to close both eyes.
d. Observe the shape and state of the skin of the eyelids, and on the edge of the eyelid, note any
abnormalities, such as the reddish.
e. Observe the growth of hair on the eyelids associated with the presence / absence of eyelashes
and eyelash position.
f. Note the breadth of the eye in the opening and note if there is a dropping of the upper eyelid or
as eye opening (ptosis).

3. Observe the conjunctiva and sclera in the following manner:

a. Instruct the patient to look straight ahead.
b. Observe the conjunctiva untukmmengetahui presence / absence of reddish, state
vascularization, as well as its location.
c. Pull the lower eyelid with your thumb.
d. Observe the state of the conjunctiva and conjunctival bag bottom, note when obtained
infection or pus or if the color is not normal, for example anemic.
e. If necessary, observe the top of the conjunctiva, which is a way to open / flip the upper eyelid
with a nurse standing behind the patient.
f. Observe the color of the sclera when examining the conjunctiva which in certain circumstances
may become jaundiced color.
g. Observe the color of the iris and pupil size and shape. Then continue with mnegevaluasi pupil
reaction to light. Normally adalam form pupil at large (isokor). The pupils were narrowed called
meiosis, and teensy-called pinpoint, while the pupils are dilated / dilated called mydriasis.
• How inspection eye movements.
a. Instruct the patient to look forward.
b. Observe whether both eyes remain stationary or move spontaneously (nystagmus) that the
rhythmic movements of the eyeball, first slowly moving toward unity, then quickly retraced to
the original.
c. If found their nystagmus, observe the shape, frequency (fast or slow), amplitude (wide /
narrow) and duration (days / week).
d. Observe whether both eyes look straight ahead or one deviates.
e. Straighten your fingers and hold your finger with a distance of 15-30 cm.
f. Tell your patient to follow the movement of your finger and keep the patient's head position.
The movement of your finger to the eight direction to determine the function of the eye muscles
6.

How inspection visual field.

he. Standing in front of the patient.
b. Assess both eyes separately, namely by closing the eyes are not checked.
c. Tell your patient to look straight ahead and focusing on one point of view, such as your nose.
d. Your finger movements on the vertical line / on the side, hold the patient kemata slowly.
e. Instruct the patient to the member knows, when you begin seeing your finger.
f. Assess the other eye.
• How examination of visual acuity (sharpness of vision)
a. Prepare the Snellen card or other card or cards for adult patients pictures for children.
b. Adjust the chair seat a patient with a distance of 5 or 6 meters from Snellen card.
c. Set adequate lighting so that the card can be read clearly.
d. Tell your patient to close the left eye with one hand.
e. Right eye examination is done by the patient asked to read from the letter that most leading small
letters and note the last post can still be read by the patient.
f. Selanjutna did the left eye examination.
• How palpation eye
On palpation eyes done in order to determine eye pressure and determine tenderness. To measure eye
pressure more thoroughly, it is necessary alan tonometry which requires special expertise.
1. Bari know the patient to sit down.
2. Instruct the patient to close her eyes.
3. Perform palpation in both eyes. When eye pressure rises, eyes palpable hard.
b) Physical examination ear.
Assessment ears generally aims untukmengetahui circumstances outside the ear, ear canal, eardrum /
membrane tipani, and hearing. Alta needs to be prepared in the assessment include an otoscope, a
tuning fork and watches.
• How inspection and palpation of the ear
1. Help the patient in the sitting position.
2. Adjust your sitting position meghadap side of the patient's ear to be studied.
3. For lighting, use auriskop, head lights, or other light source.
4. Start to observe the outer ear, check the size, shape, color, lesions, and the presence of the masses on
the pinna.
5. Continue palpation assessment by holding the ear with your thumb and forefinger.
6. palpation systematically cartilage of the outer ear, which is of the soft tissue, then hard tissue, and
note if there is pain.
7. Press the tragus and press well into the ear bones below the earlobe. When there is inflammation,
the patient will feel pain.
8. Compare the right and left ear.
9. When diperluka, continue to study the inner ear.
10. Hold the edge of the ear / helical and slowly pull the earlobe up and back so that the ear hole to be
straight and easily observed.
11. Observe the entrance of the ear hole and note the presence / absence of inflammation, bleeding or
droppings.
• Examination of hearing.
Hearing screening is done to determine the function of the ear. In a simple hearing screening can be
checked by mengguanakan whisper. Hearing that will be easy megetahui their whisper.
• How hearing screening with a whisper.
1. Adjust the position of the patient stood with you at a distance 4,5-6m
2. Instruct the patient to cover one ear were not examined.
3. The whisper number.
4. Tell the patient to repeat the numbers that are heard.
5. Check the ear next to it in the same way.
6. Compare the ability to hear the patient's right and left ear.
• How hearing screening with a tuning fork.
Hearing screening is done in order to determine the quality of hearing more thoroughly. Examination of
the tuning fork is done in two ways, namely inspection and examination Rinne Webber.
1. Examination Rinne
a. Vibrasikan tuning fork
b. Put the tuning fork on the patient's right mastoid
c. Instruct the patient to know when the members do not feel the vibe again.
d. Force tuning fork and hold it in front of the right ear of the patient with the position of the tuning fork
parallel to the outside of the patient's ear canal.
e. Instruct the patient to members know if they heard the sound vibration or not. Normally sound
vibrations can still be heard due to air conduction better compared bone conduction.
2. Inspection Webber.
a. Vibrasikan tuning fork
b. Put the fork in the middle of the peak of the patient's head
c. Asked patients about hearing ear vibration noise louder. Normally both ears can hear a balanced
manner so that the vibrations felt in the middle ear.
d. Record the results of the hearing.
3. Determine whether the patient has bone conduction disturbances, air, or both.
c) Physical examination of the nose and sinuses
Nose examined in order to determine the state of the form and function of the nasal bone. Assessment
nose starts from the outside, the inside and sinuses.
The tools need to be prepared, among others otoscope, nasal speculum, a mirror, and a source of
illumination.
• How inspection and palpation of the outside of the nose and sinus palpation
1. Sit facing the patient.
2. Adjust the lighting and nose observe the outside of the front, side and top, note form or the nasal
bones of the three sides of this.
3. Observe wanrna and swelling of the skin of the nose.
4. Observe the symmetry of the nose
5. Continue to palpate the nose outside, and record if found non abnormalan skin or the nasal bones.
6. Assess the mobility of the nasal septum.
7. palpation maxillary sinus, frontal and ethmoidal. Note that if there is pain.
• How inspection inside the nose.
1. Sit facing the patient
2. Install the lamp head, adjust the lights so precisely illuminate nostril.
3. Elevasikan patient's nostril by pressing the patient's nose gently with your thumb, then look in the
anterior nostrils.
4. Observe the position of the nasal septum and the possibility of perfusion.
5. Observe section inferior nasal concha
6. Place the tip of the nasal speculum the nostril so that the nasal cavity can be observed.
7. To facilitate the observation on the basis of the nose, position the head so it looked.
8. Observe the shape and position of the septum, the cartilage, and the walls of the nasal cavity and
mucous membranes in the nasal cavity (color, secretions, swelling)
9. When you are finished remove the speculum slowly.

How inspection visual field.

he. Standing in front of the patient.
b. Assess both eyes separately, namely by closing the eyes are not checked.
c. Tell your patient to look straight ahead and focusing on one point of view, such as your nose.
d. Your finger movements on the vertical line / on the side, hold the patient kemata slowly.
e. Instruct the patient to the member knows, when you begin seeing your finger.
f. Assess the other eye.
• How examination of visual acuity (sharpness of vision)
a. Prepare the Snellen card or other card or cards for adult patients pictures for children.
b. Adjust the chair seat a patient with a distance of 5 or 6 meters from Snellen card.
c. Set adequate lighting so that the card can be read clearly.
d. Tell your patient to close the left eye with one hand.
e. Right eye examination is done by the patient asked to read from the letter that most leading
small letters and note the last post can still be read by the patient.
f. Selanjutna did the left eye examination.
• How palpation eye
On palpation eyes done in order to determine eye pressure and determine tenderness. To measure
eye pressure more thoroughly, it is necessary alan tonometry which requires special expertise.
1. Bari know the patient to sit down.
2. Instruct the patient to close her eyes.
3. Perform palpation in both eyes. When eye pressure rises, eyes palpable hard.
b) Physical examination ear.
Assessment ears generally aims untukmengetahui circumstances outside the ear, ear canal,
eardrum / membrane tipani, and hearing. Alta needs to be prepared in the assessment include an
otoscope, a tuning fork and watches.
• How inspection and palpation of the ear
1. Help the patient in the sitting position.
2. Adjust your sitting position meghadap side of the patient's ear to be studied.
3. For lighting, use auriskop, head lights, or other light source.
4. Start to observe the outer ear, check the size, shape, color, lesions, and the presence of the
masses on the pinna.
5. Continue palpation assessment by holding the ear with your thumb and forefinger.
6. palpation systematically cartilage of the outer ear, which is of the soft tissue, then hard tissue,
and note if there is pain.
7. Press the tragus and press well into the ear bones below the earlobe. When there is
inflammation, the patient will feel pain.
8. Compare the right and left ear.
9. When diperluka, continue to study the inner ear.
10. Hold the edge of the ear / helical and slowly pull the earlobe up and back so that the ear hole
to be straight and easily observed.
11. Observe the entrance of the ear hole and note the presence / absence of inflammation,
bleeding or droppings.
• Examination of hearing.
Hearing screening is done to determine the function of the ear. In a simple hearing screening can
be checked by mengguanakan whisper. Hearing that will be easy megetahui their whisper.
• How hearing screening with a whisper.
1. Adjust the position of the patient stood with you at a distance 4,5-6m
2. Instruct the patient to cover one ear were not examined.
3. The whisper number.
4. Tell the patient to repeat the numbers that are heard.
5. Check the ear next to it in the same way.
6. Compare the ability to hear the patient's right and left ear.
• How hearing screening with a tuning fork.
Hearing screening is done in order to determine the quality of hearing more thoroughly.
Examination of the tuning fork is done in two ways, namely inspection and examination Rinne
Webber.
1. Examination Rinne
a. Vibrasikan tuning fork
b. Put the tuning fork on the patient's right mastoid
c. Instruct the patient to know when the members do not feel the vibe again.
d. Force tuning fork and hold it in front of the right ear of the patient with the position of the
tuning fork parallel to the outside of the patient's ear canal.
e. Instruct the patient to members know if they heard the sound vibration or not. Normally sound
vibrations can still be heard due to air conduction better compared bone conduction.
2. Inspection Webber.
a. Vibrasikan tuning fork
b. Put the fork in the middle of the peak of the patient's head
c. Asked patients about hearing ear vibration noise louder. Normally both ears can hear a
balanced manner so that the vibrations felt in the middle ear.
d. Record the results of the hearing.
3. Determine whether the patient has bone conduction disturbances, air, or both.
c) Physical examination of the nose and sinuses
Nose examined in order to determine the state of the form and function of the nasal bone.
Assessment nose starts from the outside, the inside and sinuses.
The tools need to be prepared, among others otoscope, nasal speculum, a mirror, and a source of
illumination.
• How inspection and palpation of the outside of the nose and sinus palpation
1. Sit facing the patient.
2. Adjust the lighting and nose observe the outside of the front, side and top, note form or the
nasal bones of the three sides of this.
3. Observe wanrna and swelling of the skin of the nose.
4. Observe the symmetry of the nose
5. Continue to palpate the nose outside, and record if found non abnormalan skin or the nasal
bones.
6. Assess the mobility of the nasal septum.
7. palpation maxillary sinus, frontal and ethmoidal. Note that if there is pain.
• How inspection inside the nose.
1. Sit facing the patient
2. Install the lamp head, adjust the lights so precisely illuminate nostril.
3. Elevasikan patient's nostril by pressing the patient's nose gently with your thumb, then look in
the anterior nostrils.
4. Observe the position of the nasal septum and the possibility of perfusion.
5. Observe section inferior nasal concha
6. Place the tip of the nasal speculum the nostril so that the nasal cavity can be observed.
7. To facilitate the observation on the basis of the nose, position the head so it looked.
8. Observe the shape and position of the septum, the cartilage, and the walls of the nasal cavity
and mucous membranes in the nasal cavity (color, secretions, swelling)
9. When you are finished remove the speculum slowly.

How assessment neck movement

Assessment of neck motion performed most recently on neck examination. This assessment is
done either actively or passively. To obtain accurate data, neck and upper chest should be free of
clothing and nurses standing / sitting behind the patient.
1) Perform assessments neck movement actively. Ask the patient to move the neck in the
following order:
a. Antefleksi, normally 45º
b. Dorsiflexion, normally 60º
c. Rotation to right, normally 70º
d. Rotate left, normally 70º
e. Lateral felksi to the left, normally 40º
f. Lateral flexion to the right, normally 40º

2) Determine the extent to which the patient is able to move his neck. Normally the movement
can be done in a coordinated manner without interruption.
• If necessary, perform assessments passive movement by way of the patient's head is held with
both hands and then moved in the same order as in the assessment of neck movement actively.

2. Examination Chest
a) Inspection
chest inspected mainly posture, shape, and symmetry expansion, as well as the state of the skin.
Posture can vary, for example, in patients with chronic respiratory problems, klavikulanya be
elevation. Breast shape is different between infants and adults. Baby's chest is circular with a
diameter from front to back (Antero-posterior) is equal to the transverse diameter. In adults, the
ratio between the antero-posterior diameter of the transverse diameter is 1: 2. The shape of the
chest so not normal in certain circumstances, such as pigeon chest, the chest forms characterized
by narrow transverse diameter, antero-posterior diameter decreases. Examples of other chest
deformity is a barrel chest marked with Antero-posterior diameter and transversal has a ratio of
1: 1. It may be observed in patients with kyphosis. When reviewing the form of a chest, a nurse
at the same time observing the possibility of spinal abnormalities, such as kyphosis, lordosis, or
scoliosis.
Chest inspection done either at the time the chest is moving or stationary, especially when
done observation of respiratory movement. Meanwhile, to observe their spinal deformities
(kyphosis, lordosis, scoliosis), it will be easier to do when the chest is not moving.
Observations chest while on the move is performed to determine the frequency, nature, and
rhythm / rhythm of breathing. Normal respiratory rate ranged between 16 to 24 times per minute
in adults. Respiratory rate more than 24 times per minute is called tachypnea.
The nature of breathing in principle, there are two kinds, namely chest breathing
characterized by the development of the chest and abdominal breathing is characterized by the
development of stomach. In general, the nature of breathing that is often found is a combination
of chest and abdominal breathing.
In certain circumstances, the respiratory rhythm may be abnormal, for example, Kussmaul
breathing, ie breathing fast and deep, as seen in patients with diabetic coma. Breathing Biot, the
respiratory rhythm and amplitude irregular, interspersed with periods of apnea, and can be found
in patients with brain damage. Cheyne-Stokes respiration, the breathing amplitude that first -
small at first, increasingly swell, then shrink again, interspersed with periods of apnea, and are
usually found in patients with neurological disorders of the brain.
Leather chest area need to be scrutinized carefully to know the presence of edema or
protrusions (tumor).

How detailed inspection of the chest

1) Remove the patient's clothes and putting out the patient's body to limit the waist.
2) Adjust the position of the patient (the position is set depending on the stage of the examination
and the patient's condition). Patients may be asked to take a sitting or standing position.
3) Make sure that the nurses were prepared (hands clean and warm), room and stethoscope
prepared.
4) Give an explanation to the patient about what will be done and recommend that patients
remain relaxed.
5) Inspect the shape of the chest of the four sides: front, back, right side and left side at rest
(rest), during inspiration and expiration. At the time of the next inspection, note the clavicle area,
supraclavicular fossa and infraclavicular fossa, sternum and ribs. From the back side, observe the
location of the 7th cervical vertebra (peak scapula lies parallel to the 8th thoracic vertebra), note
the shape of the spine and note if there is deformity. Lastly, the inspection overall shape of the
chest to detect abnormalities, such as shape barrel chest.
6) Observe more carefully record the state of the skin of the chest and if found their pulse on the
intercostal or below the heart, intrakostal retraction during breathing, scarring, and a sign - a sign
more prominent.
b) palpation
Palpation of the chest is done to assess the state of the skin of the chest wall, tenderness, mass,
inflammation, symmetry expansion, and fremitus tactile (vibration that can be felt is delivered
through bronchopulmonary system for someone to speak).
Tenderness may arise due to local injury, inflammation, malignant tumor metastasis, or pleurisy.
If found swelling or lump in the chest wall, need dideskripdikan size, consistency, and the
temperature is clearly making it easier to determine whether the abnormality is caused by bone
disease, tumors, ulcers, or an inflammatory process.
At the time of breathing, normal chest move symmetrically. Movement becomes asymmetrical in
the event of pulmonary atelectasis (lung collapse). Fremitus tactile vibration can be tougher or
weaker than normal. Fremitus tactile vibration can be tougher or weaker than normal. Vibration
becomes harder when there infiltrates. Vibration weakening found in the state of emphysema,
pneumothorax, hydrothorax, and obstructive atelectasis.
How it works palpation of the chest wall
1) Perform palpation to determine lung expansion - lung / chest wall:
a. Place both palms flat on the front chest wall.
b. Instruct the patient to inhale.
c. Feel the chest wall movement and compare the right side and left side.
d. Standing behind the patient, put your hand on the patient's chest, note the sideways movement
when the patient is breathing.
e. Place both your hands on the patient's back and compare both sides of the chest wall
movement.
2) Perform palpation to assess tactile fremitus. Ask the patient to call the number "six - six"
while nurses palpate by:
i. Place the palm of your hand on the back of the chest wall near the apex of the
lung - the lung.
ii. Repeat steps a hand moves to the base of the lungs - lungs.
 iii. Compare fremitus on both sides of the lung - the lung as well as between the
apex and the base of the lungs - lungs.
iv. Fremitus tactile palpate the anterior chest wall.

In fremitus tactile assessment, vibration / vibration talk normally be transmitted through the chest
wall. The vibe is more clearly felt in the apex of the lung - the lung. Vibration chest wall harder
than the left chest wall because the right side of the larger bronchi. In men, fremitus more easily
felt because the male voice is greater than the female voice.

Percussion
Chest percussion skills for nurses in general are not widely used to practice in the laboratory for these
skills only when necessary and under the supervision of expert instructors.
How percussion lungs - pulmonary systematically
1. Percuss lungs - lungs anteriorly with the patient supine.
a. Percussion from top to bottom on each clavicle intercostal space.
b. Compare the right and left
2. Percuss lungs - pulmonary posterior with the patient's good to sit or stand.
a. Make sure first that the patient sit up straight.
b. Starting percussion from the top of the lungs - pulmonary down.
c. Compare left and right sides.
d. Record results clearly percussion.
3. Percuss lungs - pulmonary posterior to determine the movement of the diaphragm (important in
patients with emphysema).
i. Ask the patient to take a deep breath and hold it.
ii. Starting percussion from top to bottom (from resonant to dim) until the faint sound is
obtained.
iii. Mark with a marker at the spot faint sound is obtained (usually in the 9th intercostal
space, slightly higher than the position of the heart in the right chest).
iv. Ask the patient to exhale as meksimal and hold it.
v. Percuss of sound dim (sign I) upwards. Usually the sound dim-2 is found at the top mark
on the skin Tick I. found faint sound (mark II).
vi. Measure the distance between the mark I and mark II. In women, the distance between
the two marks is normally 3-5 cm and in men is 5-6 cm.

d) Aukultasi
Aukultasi usually implemented using a stethoscope. Aukultasi useful to examine the flow of air through
the tracheobronchial trunks and determine airflow obstruction. Aukultasi also useful to assess the
condition of the lung - the lung and pleural cavity. To be able to perform auscultation, the nurse must
know the sound / breath sounds are categorized according to intensity, tone, and duration between
inspiration and expiration How it works to perform auscultation
1. Sit facing the patient.
2. Ask the patient to breathe normally, start auscultation with a stethoscope put on the trachea, and
with the sound of breathing carefully.
3. Continue auscultation breath sounds were normal with directions as to percussion and see if there
are additional.
4. Repeat auscultation of the chest as well as the lateral and posterior bandngkan right and left sides.

3. Examination ABDOMINAL
a) Inspection
Inspections carried out first to determine the shape and movement - the movement of the abdomen.
How it works inspection
1) Set the proper position
2) Observe the general shape of the abdomen, the contours of the surface of the abdomen, and their
retraction, protrusion, and asymmetry.
3) Observe the movement of the abdominal skin during inspiration and expiration.
4) Observe hair growth and pigmentation of the skin more thoroughly.
b) Auscultation
Nurses perform auscultation to listen to two voices abdomen, the bowel (peristaltic) caused by the
displacement of gas or food along the intestine and the sound of the blood vessels. This technique is
also used to detect the patient's gastrointestinal function after surgery.
In certain circumstances, a voice is heard through auscultation may weaken. Auscultation may also be
made to listen to the heartbeat of the fetus in pregnant women.
How it works auscultation
1) Prepare a stethoscope, warm hands and part of the diaphragm when cold examination room.
2) Ask the patient about the time the last meal. Bowel sounds may increase after eating.
3) Determine the portion stethoscope to be used. Part diaphragm is used to listen for bowel sounds,
while the bell (lid) for voice mmendengarkan blood vessels.
4) Put the diaphragm with light pressure on each area of the four quadrants of the abdomen and listen
to the sound of peristaltic active and sound of sobbing sounds (gurgling) that normally sounded every 5-
20 seconds with a duration of less or more than one second. The frequency of the sound depends on the
digestive status or the presence or absence of food in the digestive tract. In its reporting, bowel sounds
can be expressed by "sounding, no / hypoactive, very slow" (ie, just sounded once per minute) and
"hyperactivity or increased" (eg, sounding every 3 seconds). When bowel sounds rarely / no, listen first
for 3-5 minutes before ascertained.
5) Place the bell (lid) stethoscope over the aorta, renal artery and the iliac artery. Listen to the sound -
the sound of the arteries (bruit). Auscultation is done from the aorta superior to the umbilicus.
Auscultation of the renal artery is done by placing a stethoscope on the midline of the abdomen or left
of the line towards the right upper abdomen approached the pelvis. Auscultation iliac artery is done by
putting a stethoscope on the area under the umbilicus on the right and left of the midline of the
abdomen.
6) Place the bell of the stethoscope on preumbilikal area (around the umbilicus) to listen to noisy veins
(rarely heard).
7) In doing auscultation in all areas, particularly the area of the liver and spleen, also examine the
possibility of sound - a scraping sound like rustling two objects.

8) To assess rustling in the spleen area, place a stethoscope on the boundary area below the ribs on the
anterior axillary line and ask the patient to take a deep breath. To assess the rustling in the liver area,
put a stethoscope on the bottom right side of the rib.

c) Percussion
Percussion performed to listen / detect the presence of gas, liquid, or a mass in the abdomen.
Percussion also conducted to determine the position of the spleen and liver. Percussion of the abdomen
which is normal timpani, but the sound may change in circumstances - circumstances. For example,
when an enlarged liver and spleen, percussion will be dim, particularly percussion in the area bawwah
kostalis arch right and left. If there is free air in the abdominal cavity, the liver dullness area will be lost.
In the state usu contains too much fluid, the sound produced on percussion entire abdominal wall is
hipertimpani, while the liver area remain deaf. Percussion on the area containing the liquid will also
produce sound dull. Percussion abdominal exercises for nursing students should be guided by
experienced instructors and master the abdominal assessment.

Percussion abdomen in a systematic way

1) Perfusion starting from the upper right quadrant then move clockwise (from the point of view /
perspective of the patient).
2) Consider the reaction of patients and record when the patient feels pain or tenderness.
3) Do the percussion of the timpani and dim areas. Timpani sound has characteristics higher than
resonant tone. Sounds can be heard on the tympanic cavity or organs that contain air. Dim voice has the
tone characteristics lower or flatter than resonant. This voice can be heard in a dense mass, for example
the state of ascites, the state of bladder distension, and enlarged liver and spleen or tumor.
d) Palpation
• The liver palpation
Palpation of the liver can be done bimanual, especially to determine the magnification.
How palpation liver:
1) Stand on the right side of the patient.
2) Put your left hand on the posterior thoracic wall about - about the ribs 11 or 12.
3) Press your left hand to the top so slightly lift the chest wall.
4) Place the right hand on the lower limit of the right side of the rib cage at an angle about - about 45o
from the rectus abdominis muscle or parallel to the rectus abdominis muscle with finger - the finger
towards the ribs.
5) While the patient's exhalation, apply pressure as deep as 4-5 cm towards the bottom at the
boundaries of the ribs.
6) Keep your hand position and ask the patient inhalation / breath in.
7) While the patient's inhalation, feel the liver boundary moves against your hand that is normally felt
with regular contours. If the liver does not feel / felt clearly, ask the patient to take a deep breath, while
you still retain the position of the hand or put pressure a little deeper. Difficulty in feeling the liver is
often experienced in obese patients.
8) If the enlarged liver, palpation at the lower limit of the right ribs. Please note the enlargement and
indicate by how many centimeters enlargement occurs below the rib cage.
Palpation of the liver (Source: Kozier, B., et al. (2004) Fundamentals of Nursing: Concept, process, and
practice. New Jersey: Prentice Hall).
• palpation Kidney
At the time of kidney palpation, the patient supine and nurses palpate standing on the right side of the
patient.
How palpation Kidney
1) In the palpation of the right kidney, place your left hand on the bottom of the pelvis and kidney
elevasikan anteriorly.
2) Place your right hand on the anterior abdominal wall in the midclavicular line at the lower edge of the
costal margin.
3) Press your right hand directly upwards while the patient took a deep breath. Kidneys are not palpable
in normal adults, but in people who are very thin, the bottom of the right kidney can be felt.
4) When kidneys palpable, feel the contour (shape), size, and observe tenderness.
5) To conduct palpation of the left kidney, do it in the left side of the patient's body, and place your
hands under the pelvis then perform actions such as palpation of the right kidney.
• palpation Spleen
The spleen is not palpable in normal adults. Spleen palpation performed using a pattern like on
palpation of the liver.
How Palpation Spleen:
1) Instruct the patient to tilt to the right side so that the spleen is closer to the abdominal wall.
2) palpate the lower limit of the left rib cage by using a pattern like on palpation of the liver.
Palpation of the spleen (Source: Bickley, L. S., & Szilagyi, o.g. (2004). Bate's Pocket Guide Physical
Examination and History Taking. Philadelphia: Lippincott Williams & Wilkins).
• Bladder palpation
Palpation of the bladder can be done by using one or two hands. The bladder is palpable, especially
when it becomes distended with urine accumulation. If found distention, doing percussion on the area
of the bladder to determine voice / tingakatan ruination.
4. Examination GENITAL
a) Physical Examination Male Genital Mutilation
1) Inspection
• First - an inspection of all pubic hair, consider the deployment and pubic hair growth patterns. Note if
the pubic hair grows very little or absolutely nothing.
• Inspection of the skin, the size, and the presence of other disorders that appear on the penis.
• In men who are not circumcised, hold the penis and the foreskin of the penis open, observe the
opening of the urethra and penis head to detect ulcers, scars, bumps, inflammation and discharge (if the
patient is embarrassed, the penis can be opened by the patient themselves). Normal urethral orifice is
located in the middle of the head of the penis. In some disorders, there urethral orifice located below
the shaft of the penis (hypospadias) and there is located above the shaft of the penis (epispadia).
• Inspection of the scrotum and note if there are signs of redness, swelling, ulcers, excoriation, or
nodular. Lift the scrotum and observe the area behind the scrotum.
2) Palpation
This technique is done only when there is an indication or complaint.
• Palpate the penis to detect tenderness, lumps, and the possibility of a thick liquid that comes out.
• palpation of the scrotum and testes by using the thumb and first three fingers. Palpation of each testis
and note the size, consistency, shape, and kelicinannya. Normal testis palpable elastic, smooth, no
lumps or masses, and measuring about 2-4 cm.
• palpation of the epididymis that extends from the top of the testicle to the rear. Normally soft
epidiimis palpable.
• palpation of the vas deferens with the thumb and forefinger. Sperm ducts are usually found at the top
of the lateral portion of the scrotum and palpable harder than the epididymis.
b) Physical examination Female Genital
1) palpation of external genitals
• Begin by observing the appearance of pubic hair, note the distribution and numbers, and compare the
patient's age appropriate development.
• Observe skin and pubic area, note the presence of lesions, erythema, fissures, leukoplakia, and
excoriation.
• Open the labia majora and observe the inside of the labia majora, labia minora, clitoris, and urethral
meatus. Note any swelling, ulcers, discharge, or nodular.
2) palpation of the genitals inside
• Lubricate your index finger with sterile water, insert it into the vagina, and the identification of
tenderness as well as the surface of the cervix. This action is beneficial to use and select the proper
speculum. Remove the finger when finished.
• Place two fingers on the door of the vagina and point downward toward perianal.
• Insert speculum with angle of 45 °
• Open the speculum blades, put on the cervix, and so lock bar remains open.
• If the cervix is visible, set light to clarify the vision and observe the size, lacerations, erosion, nodular
masses, discharge, and cervical color. Normally a circular or oval shape of the cervix in nulliparous, while
in the slit-shaped.
• Perform bimanual palpation basis. Wear gloves and lubricate your index finger and middle finger, and
then insert the finger into the vaginal opening with an emphasis towards the posterior, and palpate the
vaginal wall to determine tenderness and nodular.
• Cervical palpation with two fingers and note the position, size, consistency, regularity, mobility, and
tenderness. Normally the cervix can be driven without pain.
• palpation of the uterus by means of a finger - the finger in the vagina mengahadap upward. Hand is
out put in the abdomen and point downward. Palpation of the uterus to determine the size, shape,
consistency, and mobility.
• ovarian palpation by sliding two fingers in the vagina into the right lateral formiks. Hand in the
abdomen pressed to the bottom towards the lower right quadrant. Ovarian palpation of the right to
determine the size, mobility, shape, consistency, and tenderness (normally not palpable). Repeat for
ovarian next to it.
5. Examination BREAST AND armpit
In doing breast examination, especially in women, nurses should consider the psychosocial
aspects, not the physical aspects. This is because the female breast has a broad meaning, both in terms
of cultural, social, and sexual function. Breast developing and growing the life span that is affected by
the development / growth of a person, the environment, and other sociocultural.
a) Inspection
1) Help the patient adjust the sitting position facing forward, bare chest with both arms relaxed at your
sides.
2) Start the inspection of size, shape, and symmetry of the breast. Breast normally circular, somewhat
symmetrical, and can be described small, medium, and large.
3) Inspection of color, lesions, vascularity and edema in breast skin.
4) Inspection warrants areola. Areola pregnant women are generally darker in color.
5) Inspection of the protrusion or retraction in the breasts and nipples due to scarring or lesions.
6) Inspection of the discharge, ulcers, movement, or swelling of the nipples. Observe also the second
position the nipple which normally have the same direction.
7) Inspection armpit and clavicle to detect signs of swelling or reddish - pink.

b) palpation
1) Palpate around the nipple for any discharge mengetahuii. If the discharge is found, the identification
of the source, quantity, color, consistency of the discharge, and assess for tenderness.
2) Palpation of the clavicle and armpit area, especially in the area of the lymph nodes.
3) palpate each breast with a bimanual technique especially for large peyudara. The trick is to emphasize
the palm of your hand / three middle fingers to the surface of the breast on the top side quadrant.
Palpation of the chest wall with a circular motion from the edges toward ereola and clockwise.
4) Perform breast palpation next to it.
5) If necessary, do likewise assessment with the patient naked and propped a pillow / blanket under her
shoulders.
Physical examination of the nose and pharynx
Assessment of the mouth and pharynx is done with the patient sitting. Lighting should be good, so that
all parts of the mouth can be observed clearly. Observation begins by observing the lips, teeth, gums,
tongue, mucous membranes, inner cheek, floor of the mouth, and platum / palate, and pharynx.

• How inspection mouth

1. Help the patient sitting opposite and parallel to your height.
2. Observe the lips for the presence of congenital abnormalities, cleft lip, lip color, ulcers, Lessi and
mass.
3. Continue on observations of the teeth, instruct the patient to open the mouth.
4. Set the proper lighting, if necessary, use a tongue depressor, so that the teeth seem obvious.
5. Observe position, distance, Rahan upper and lower teeth, size, color, lesion, or tumor on each tooth.
Observe also the roots of the teeth and gums in particular.
6. Check each gear by tapping systematically compare the tooth left, right, up, and down, and instruct
the patient to know if the members feel pain during tooth tapped.
7. Note also common characteristic among other when assessing the kenersihan mouth and bad breath.
8. Continue observations on the tongue and note kesimetrisannya. Ask the patient stuck out his tongue
and observe straightness, color, ulcers and any abnormalities.
9. Observe the color, swelling, tumor, secretion, inflammation, ulcers, and bleeding in the mucous
membranes of the mouth systematically all.
10. Then continue on the inspection of the pharynx, by encouraging the patient opened her mouth and
pressing the tongue down the patient when the patient says "ah". Observe the symmetry of the uvula of
the pharynx.

• How palpation mouth

Palpation of the mouth do especially when the inspections have not obtained convincing data. The goal
was to determine the shape and any abnormalities that can be detected by palpation, which covers the
cheeks, floor of the mouth, palate and tongue.
1. Set a sitting position facing you, instruct the patient opened his mouth.
2. Hold the cheek between thumb and forefinger. Palpation cheek systematically, and note the presence
of a tumor or swelling. If there is swelling, determined according to the size, consistency, relationship
with the surrounding area, and pain.
3. Continue platum palpate with the index finger and feel the bumps and fissures.
4. palpation basic mouth by asking the patient to say "el", then palpate the floor of the mouth
systematically with the index finger of his right hand, note if found swelling.
5. palpation by asking the patient's tongue stuck out his tongue, hold the tongue with sterile gauze using
the left hand. With the index finger of his right hand, palpate the tongue, especially the back and the
boundaries of the tongue.

e) A physical examination of the neck

Head neck examined after the assessments completed. The goal was to determine the shape of the
neck, as well as vital organs related. In this assessment, the patient's clothes should be released, so that
the neck can be easily assessed.

• How inspection neck

1. Instruct the patient to disrobe, set good lighting.
2. Inspect the neck to determine the shape of the neck, skin color, swelling, scarring, and their masses.
Palpation done systematically, starting from the center line of the front side of the neck, side and rear.
Neck skin color is normally the same as the surrounding skin. Neck skin color can be yellow on all types
of jaundice, and becomes red, swollen, hot, and no tenderness when experiencing inflammation.
3. Inspection of the thyroid by asking the patient to swallow, and observe the movement of the thyroid
gland in the jugular notch sterni.
Normally the movement of the thyroid gland can not be seen except in people who are very thin.

How to palpation of the neck

Palpation of the neck is done primarily to determine the circumstances and location of lymph nodes,
thyroid gland and trachea.
1. Sit in front of the patient
2. Instruct the patient to look up laterally away from the nurse examiner so that the soft tissues and
muscles will be relaxed.
3. Perform a systematic palpation, and specify by location, boundaries, size, shape and tenderness in the
lymph nodes of each group consisting of:
a. Preaurikular - in front of the ear
b. Postauricular - Superficial against processus mostoideus
c. Occipital - at the base of the posterior skull
d. Tonsillar - corner of the mandible
e. Submandibular - halfway between the corners and ends of the mandible
f. Submental - on the center line a few centimeters behind the tip of the mandible
g. Cervical superficial - superficial to sternomastoid
h. Posterior cervical - along the anterior edge of the trapezius
i. Cervical in - in sternomastoid and often can not be palpated
j. Supraclavicular - in an angle formed by the clavicle and sternomastoid.
4. Perform palpation of the thyroid gland by:
a. Put your hands on the patient's neck
b. Suprasternal fossa palpate with the index finger and middle finger
c. Ask the patient to swallow or drink for easy palpation
d. Palpation may also dilakuakan with a nurse standing behind the patient, hands placed around the
neck and palpation performed with the second and third fingers.
5. Palpate the trachea by standing right beside the patient. Put your middle finger on the bottom of the
trachea and tracheal touch up, down, and sideways so that the position of the trachea can be known.

• How assessment neck movement

Assessment of neck motion performed most recently on neck examination. This assessment is done
either actively or passively. To obtain accurate data, neck and upper chest should be free of clothing and
nurses standing / sitting behind the patient.
1) Perform assessments neck movement actively. Ask the patient to move the neck in the following
order:
a. Antefleksi, normally 45º
b. Dorsiflexion, normally 60º
c. Rotation to right, normally 70º
d. Rotate left, normally 70º
e. Lateral felksi to the left, normally 40º
f. Lateral flexion to the right, normally 40º

2) Determine the extent to which the patient is able to move his neck. Normally the movement can be
done in a coordinated manner without interruption.
• If necessary, perform assessments passive movement by way of the patient's head is held with both
hands and then moved in the same order as in the assessment of neck movement actively.