Health

examination
Ms christine
Mn prev
DEFINITION
Health examination
Health examination is the systematic
assessment of human body which involves the
use of ones senses to determine the general
physical and mental conditions of the body

Physical examination
Physical examination is defined as a complete
assessment of a patients 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

EQUIPMENT USED FOR PE
STETHOSCOPE
OPHTHALMOSCOPE

OTOSCOPE
SNELLEN CHART
NASAL SPECULUM
VAGINAL SPECULUM

TUNING FORK
PERCUSSION HARMER
SPHYGMOMANOMETER

POSITIONING

Sitting/fowlers
STANDING
SUPINE AND PRONE
DORSAL RECUMBENT
Sims
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 patients chest
Square drum containing test tube, gauze
piece, cotton swab, specimen bottle,
swabsticks
Gloves
lubricant

ARTICLES REQUIRED
Torch
Ophthalmoscope
Snellens 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
EXAMINATION
Powder, soap
Snellans 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 (beaus 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
WEBERS 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
Rombergs 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
ALLENS TEST
BUERGERS TEST
CAPILLARY REFILL
HOMANS SIGN
PALPATE PERIPHERAL PULSES

DOCUMENTATION OF DATA

AFTER CARE OF THE PATIENT

AFTER CARE OF ARTICLES