EXAMINATION HEAD, FACE AND LEHER

1. Head Examination
Inspection:
 Head shape (round, oval, lump, large / small, symmetrical / not)
 Scalp clean what dirty, there is no dandruff, no wounds or not
 Hair (spreading, color, smelling not)
palpation
 Blackhead (concave / flat / convex)
 There is a benjoalan
 Hydrocephalus is present / not
2. Eye Examination
Inspection:
 Completeness and symmetry of the eye
 Is there ekssoftalmus (protruding eye), or Enofthalmus (drowning eyes)
 Eyelid / palpebra: is there oedem, ptosis, inflammation, cuts, or lumps
 Eyelashes: fall off or not
 Conjunctiva and sclera, is there any color change, redness, yellow or pale.
 Iris color and pupil reactions to light, miosis / shrink, midriasis / dilebar, pin point
/ small, nominal isokor / pupil as large.
 Cornea, the red color is usually due to inflammation, white or gray in the corneal
arcus (arcus senilis), blue, green racial influence. Observe the corneal status,
 Nigtasmus: rhythmic movements of the eyeballs
 Visus Inspection
With a distance of 5-6 M with snellen card check the OD / OS visus
5/5 or 6/6 = normal
1/60 = Can see with finger count
1/300 = Able to see with a wave of hands
1 / = Able to see dark and light
0 = Unable to see
 Field inspection
Haemi anoxia: can not be separated from the field of vision
Haemoxia: The client can not see a quarter of the field of vision
  Examination of eyeball pressure
By using tonometry or palpation of the eyeball to determine the existence of
tenderness or consistency of the eyeball.
3. Nose Check
Inspection and palpation
 Observe the shape of the nasal bone and posis septum rice (is there bending or not)
 Observe the meatus, is there bleeding, excrement, swelling, nasal mucosa, is there any
enlargement (polyp)
4. Ear
Inspection
 ear shape (symmetric / not)
 ear size (small / large)
 tension and ear
 there is no bleeding
 Full / ruptured ear membranes
palpation
 the tilt of the ear
Test the ability of ear sensitivity:
 with a whisper at a distance of 4.5-6 M to test the hearing ability of the left and right
ear
 with a watch with a distance of 30 Cm, compare the ability to hear the right and left
ears
 with tuning fork do weber test: knowing the balance of conduction of sound heard by
client, normally client hear balance between right and left
 with a tuning fork do a rinne test: to compare the auditory ability between bone
conduction and air conduction, normally the client is able to hear the sound of the
tuning fork from the air condition after sound from bone condition
 with tuning fork do swabach test: to compare the conductive conductivity of air
between the examiner and the lien, provided that the examiner is normal hearing.
5. Oral Examination and Faring
Inspection and Palpation
 Observe the lips, to know conginetal abnormalities (labioseisis, palatoseisis, or
labiopalatoseisis), pale lip color, or red, is there a lesion and mass.
 Observe teeth, gums, and tongue, are there caries, dirt, completeness, dentures,
gingivitis, tongue color, bleeding and abscesses.
 observe the state of the tongue, the color of the tongue, what dirty is not, there are
white patches or not, normal / not
 Observe oropharynx or oral cavity, bad breath, uvula symmetrical or not
 Is there any enlargement of tonsils, T: 0, Already operated, Q: 1, Normal size, Q: 2,
Tonsil enlargement not until midline, Q: 3, Magnification up center line, Q: 4,
 Notice the voice of the client there is a change or not
 Notice whether the mucus and foreign objects or not

6. Neck Examination
Inspection and palpation
 Symmetrical neck or not, ektomorph / lean is found in people with poor nutrition, or
tuberculosis, whereas endomorphs are found in obesity clones, is there inflammation,
scarring, discoloration, and mass
 Thyroid gland, there is enlargement or not by groping on suprasternal at the time the
client swallows, normally not palpable except in a skinny person
 Jugular vein, no enlargement or not
 Palpate on the neck to know the enlargement of lymph glands, thyroid gland and
tracheal position
 Lymph node lymph node (lymph node adenopathy) indicates inflammation of the
head of the chest, infection of tuberculosis, or syphilis.
 Enlarged thyroid may occur due to iodine deficiency
 Note the position of the trachea, when shifted or not symmetrical can occur due to the
process of urge space or fibrosis in the lungs or mediastinum
7. Integument
Inspection:
 Are there lesions, color, scarring, vascularization.
 Skin color :
Chocolate, melanin deposit
Blue, Hipoxia peripheral tissue
Red, increased oxihaemoglobin
Pale, Anoxia skin tissue
 Yellow, an increase in indirect bilirubin in the blood

Palpation:
 Skin temperature, smooth / rough texture, torgor / elasticity wrinkles / tension, degree
oedema how much?
0 = normal
+ 1 = less / = 2
+ 2 = 3-4
+ 3 = 5-6
+ 4 = more / = 6

 Identification of skin lesions

 Primary Type
o Makula: Skin color change, not palpable, clear boundary, circular shape less than 1
Cm, Patch: circular shape more than 1 Cm
o Papula: Prominent, clear border, dense skin elevation, less than 1 Cm, Plaque more
than 1 Cm
o Nodule: Solid protrusions are clearly bounded, deeper and clearer than the 1-2 cm
Cm, Tumors greater than 2 cm
o Vesicles: Projection on skin, round shape, serous fluid, diameter less than 1 cm,
Bull diameter greater than 1 cm
o Secondary Type
o Pustula: Vesical / Bulla containing pus
o Ulcers: Open wounds caused by broken vesicles / bulls
o Crusta: A drying body fluid (serum, blood / pus)
o Exsoriation: Epidermal peeling
o Scar: Rupture of skin tissue to form a crack gap
o Lichenification: Thickening of the skin due to scratching or pressing down
o Skin Disorders:
o Naevus Pigmentosus: Hyperpigmentation of the skin with clear boundaries
o ( mole )
o Hyperpigmentation: Skin areas darker than others (Cloasma Gravidarum)
o Vitiligo / Hipopigmentation: Less pigmented skin area
 o Tatto: Artificial hyperpigmentation
o Haemangioma: Reddish spots on blood vessels, can
o is a benign tumor or mole
o Angioma / anyway: The swelling that is formed by proliferation
o the excess of the blood vessels
o Spider Naevi: Dilation of arteriole blood vessels by shape
o the flow of a khasseperto scorpion and when pressed hlang
o Strie: White lines on the skin that occur akiubat widening the skin, can be found in
pregnant women
8. Nail Examination
Inspection and palpation
 Color, shape, cleanliness
 Nail Sections:
Matrix / nail root: where the nail plate grows
Nail plate
Basic nails: with nail plate
Peringeal tissue: consists of ephonicium, perionycium

9. Examination Of Breast And Potential

Inspection
 Breast size, shape, and symmetry, and is there any swelling. Normally circular and
symmetrical with small, medium or large size.
 Breast skin, color, lesions, vascularization, edema.
 Areola: Is there a change of color, in a darker pregnant woman.
 Putting: Is there any fluid coming out, ulcers, swelling
 Is there an enlargement in the lymph nodes of the axillar and clavicle
Palpation:
 Is there a secret of putting, is there a push, and suppleness.
 Is there a mass lump or not

10. Examination Of Torak And Paru

Inspection
 The shape of piston, symmetry, skin condition.
 Normal chest: proximodistal diameter is longer than anterodistal
 Pigeon chest: anteroposterior diameter longer than proximodistal
 Funnel chest: anteroposterior diameter shorter than proximodistal
 Barrel chest: anteroposteriol diameter is the same as proximodistal
 Kyposis: the spine is bent forward
 Scoliosis: The spine is bent into sanping
 Lordosis: the spine is bent backward
 Observe the client's breathing: frequency (16-24 X per minute), intercostal retraction,
suprasternal retraction, nasal lobe breathing.
 Various respiratory patterns:
Eupnea: Rhythm and normal breathing rate
Takipneu: Increased speed of breathing
Bradipnea: Slow but normal breathing
Apnea: There is no respiration
Chene Stokes: Breathing gradually faster and deeper, and slows down in the pereode
of apnea
Biot's: Breathing fast and deep with a sudden stop.
Kusmaul: Breathing fast and deep without stopping
 Observe no / no cyanosis, productive or dry cough.
Palpation
 Examination of tactile / vocal fremitus: comparing the vibration of the piston wall
between right and left, by placing the palm of the examiner's hands on the client's
back and lien prompted to say seventy-seven words, palms are shifted down and
compare their vibrations, normally vibrations between right and left are palpable
same.

Percussion
 Sticking the middle finger of the examiner on the client's intercosta and tapping with
the other finger, normally the sound of the piston wall when it is enchanted is the
sonor. Hipersonor indicates the presence of compaction of lung tissue or fluid
accumulation in the piston wall (pnemotorak)
Auscultation
 The sound of the breath
 Vesicular: heard throughout the lung field with low sound intensity, soft and clean.
Bronchial: above the sterni manubrium, high sound, hard and clean
Bronkovesikuler: Intercosta 1 and 2, and between scapula, medium and clean intensity
Tracheal: above the trachea on the neck, very high imtensity, hard and clean

 Speech Sound
Encourage the client to say seventy-seven repeatedly, with the stethoscope listening
on the piston area, normally the intensity of the left and the same sound
Abnormalities that can be found:
Bronkophoni: Sound sounds louder on the other side
Egophony: The voice echoed (nasal)
Pectoriloqy: The sound is distant and unclear

 Additional sound
o Rales: Sound that comes from sticky exudates during inspiration
Rales smooth, sounds smooth smooth at the end of inspiration
Rales is rough, sounds muffled throughout inspiration
Rales is not lost with cough
o Ronchi: Due to the buildup of exudates in large bronchus, heard in the
inspiration and expiration phase, disappears when the client coughs
o Wheezing: Hearing in inspiration from bronchial narrowing
o Pleural tricion rab: sounds grainy as sandpaper rubbing due to pleural
inflammation heard throughout breathing more clearly on the lateral antero
under the piston wall
Palpation
 The existence of pulsation on the piston wall, normally no pulsation:
ICS II (aortic area on the right and pulmonary on the left)
ICS IV left (tricuspidal area or right ventricle)
ICS V Mid Clavicle left (area Bicuspidalis)

Percussion
The purpose of percussion is to know the size and shape of the heart is rough, normal heart
limits
 Auscultation
 Listen to BJ I on ICS IV left sternal line BJ I Tricuspidalis, and on ICS V Mid
Clavicula / Apex BJ I bicuspidalis sounded lub harder due to the closure of the mitral
da tricuspidalis valve.
 Listen to BJ II on ICS II of the right sternal line of BJ II Aorta, and ICS II or III left
sternal line BJ II aorta, heard DUB from aortic and pulmonary closure.
 Listen to BJ III (if any) heard in the mitral area, at the beginning of diastolic sounding
LUB-DUB-EE, BJ III sounds normal in children, young adults and pregnant people.
If any BJ III in adults accompanied by oedema / dipsneu means abnormal. BJ III on
the client decompensated cordis called Gallop Rhythm, which occurs due to
vibrations due to swift charging of the left ventricle from the left atrium from the
narrow space to the wider space.
 Listen to the sound of murmurs, additional sounds in the systolic, diastolic phase
resulting from the vibration of the heart or blood vessels due to the turbulent flow of
blood.
 Degree of Murmur:
1: Almost unheard
2: It sounds weak
3: Somewhat hard
4: Hard
5: Very loud
6: Until the stethoscope in the lift a little sound is still heard

11. Examination Of Abdomen / Stomach

 Specifically for abdominal examination the sequence is inspection, auscultation,
palpation, and percussion, as palpation and percussion can improve the intestinal
lining of the intestine.
 The abdomen is divided into 4 Quadrants and 9 Regions:
Inspection
 Abdominal shape: Bloated, or flat
 Massa / Lump: on what area and what shape
 The symmetry of the abdominal shape
 Observe the shadow of the veins, if seen at the top of the abdomen and flow to the
upper part, there is an obstruction of the portal vein of hepatica, if it appears at the
bottom of the abdomen upwards there is an obstruction in the inferior vena cava,
normally if visible blood vessels in the abdomen comes from the middle up or down,
and does not look too prominent.
Auscultation
 To know bowel peristaltic or bowel sounds. Record the frequency in one minute,
normally 5-35 times per minute, a long, hard, peristaltic sound called Borborygmi
usually occurs in the client's gastroenteritis, and when very slow (meteorismus) in the
paralytic ileus client.
Palpation
 Smack on the client which part is experiencing the pain.
 Palpate Hepar:
o Set the patient's position on your back and legs bent
o The nurse stands to the right of the client, and puts a hand under the costai arcus
12, at the time of isppiration do palpation and description:
o Whether or not the tenderness exists, there is or is not an enlarged number of
fingers from the arcus costae, hard or soft palate, smooth or bumpy surface, sharp
or sharp edges of the hep. Normally the liver is not palpable.
 Palpation Lien:
o The patient's pose stays on your back, make a line of Schuffner's shadow from the
left midclavicle to the arcus costae- via umbilicus - ending in SIAS then the line
from the arcus costae to SIAS in the eight split. With Bimanual do the palpation
and discontinue tenderness lie on the Scuffner line to how much? (showing
enlargement of the lien)
 Palpation Appendix:
o The patient's position stays on your back, Make a shadow line to determine the
point of Mc. Burney is by drawing the shadow line from umbilicus to SIAS and
divide into 3 parts. Press on the outside third of Mc Burney's point: If there is
tenderness, the pain relieves and the pain radiates contralaterally there is
inflammation in the appendix.
 Palpation and Percussion To Know there are Acites or not:
 o Percussion from the lateral to the medial part, the sound change from timoani to
dullnes is the boundary of the acites fluid
o Shiffing Dullnes, with a change in the right tilted position / tilted to the left, the
presence of fluid acites will flow in accordance with gravity, with lateral side
percussion results more dullness / dullness
o Normally the result of percussion on the abdomen is tympani.
 Kidney Palpation:
o With the left hand bimanual lifting the kidneys to the anterior at the posterior
lumbar area, the right hand is placed under the arcus costae, then palpate and
describe whether there is tenderness, shape and size.
o Normally the kidneys are not palpable

12. Genetalia Examination

a) Male Genetalia
Inspection:
 Observe the spread and cleanliness of pubic hair
 The skin of the penis and scrotum is no lesion, swelling or lump
 The urethral hole is a blockage, the urethral opening at the bottom (Hipospadia) of
the urethral opening in the penis (Epispadia)
Palpation
 Penis: is there stress press, bumps, fluid out
 Scrotum and testis: Is there a beniolan, press press, penis size, testis normally palpable
elastic, slippery and no bumps.
 Abnormalities seen in the scrotum:
 Hydrocele: the induced serosa of the visceral and parietal membranes in tunica
vaginalis.
 Hernan scrotal: Hernia in the scrotum
 Spermatocele: Cysta epididymis, formed by, obstruction of the tubules / sperm ducts.
 Epididmal Mass / Nodularyti: Due to the presence of benaign or malignant
neoplasms, syphilis, or tuberculosis.
 Epididmitis: Inflammation or infection by Escherichia coli, Gonorrhoe, or
Mycobacterium tuberculosis.
 Torsion of the sperm channel: Axil rotation or vuvulus in the sperm channel is caused
by infarction of the testes.
 Testiscular tumor: tumors in the testes cause some of its properties are usually not
sick.
Inspection and palpation Hernia:
 Observe the inguinal and femoral regions, is there any swelling. Before palpation,
Encourage the client to stand with a foot, with a side that will be slightly bent. Put
your index finger into the skin of the scrotum and push up the external inguina ring.
When the enlarged ring prompts the client to strain or cough, in this way the inguinal
hernia will be palpable.