HEAD TO TOE PHYSICAL EXAMINATION

HEAD TO TOE PHYSICAL EXAMINATION – General status, Mental status, Height and Weight, Skin Conditions, Head and Face, Eye, Ears, Nose, Mouth and Pharnyx, Neck, Chest, Abdomen, Neurological Tests.

The examination is carried out in an orderly manner focusing upon one area of the body at a time. The observation of the patient starts as the patient walks into the examination room, e.g. a limp may be noted as the patient walks in. the following observations are made:

GENERAL APPEARANCE

  • Nourishment: well nourished or under nourished
  • Body build: thin or obese
  • Health: healthy or unhealthy
  • Activity: active or dull (tired)

MENTAL STATUS

  • Consciousness: conscious, unconscious, delirious, talking incoherently
  • Look: anxious or worried, depressed, etc
  • Body curves: lordosis, kyphosis, and scoliosis
  • Movement: any limb

HEIGHT AND WEIGHT

Skin Conditions

  • Color: pallor, jaundice, cyanosis, flushing, etc
  • Texture: dryness, flaking, wrinkling or excessive moisture
  • Temperature: warm, cold and clammy
  • Lesions: macules, papules, vesicles, wounds, etc

HEAD AND FACE

  • Shape of the skull and fontanel
  • Skull circumference
  • Scalp: cleanliness, condition of the hair, dandruff, pediculi, infections like ringworm
  • Face: pale, flushed, puffiness, fatigue, pain, fear, anxiety, enlargement of parotid glands, etc

EYE

  • Eyebrows: normal or absent
  • Eyelashes: infection, sty
  • Eyelids: edema, lesions, ectropion, entropion
  • Eyeballs: sunken or protruded
  • Conjunctiva: pale, red, purulent
  • Sclera: jaundiced
  • Cornea and iris: irregularities and abrasions
  • Pupils: dilated, constricted reaction to light
  • Lens: opaque or transparent
  • Fundus: congestion, hemorrhagic spots
  • Eye muscles: strabismus (squint)
  • Vision: normal, myopia, hypermetropia

ARTICLES APPROPRIATE FOR SPECIFIC EXAMINATION

  • Eye: torch, ophthalmoscope, snellen chart, wisp of cotton
  • Ear: head mirror, light bulb fixed on the wall or a table lamp and a torch, a tuning fork
  • Nose: nasal speculum, forceps, a head mirror and a light bulb
  • Throat: tongue depressor, a laryngeal mirror, a kidney tray, a paper bag, throat swabs in a container. Torch, gauze pieces in a bowl
  • Chest and abdomen: stethoscope, tape measure
  • Vaginal: sterile vaginal speculum, gloves, a kidney tray, a bowl with swabs (sterile), an antiseptic lotion
  • Rectal: proctoscope, gloves, finger cots, a kidney tray, water-soluble jelly
  • Neurological: a percussion hammer, safety pins, a wisp of cotton, hot or cold water

EARS

  • External ear-discharges, cerumen obstructing the ear passage
  • Tympanic membrane: perforations, lesions, bulging
  • Hearing: hearing acuity

NOSE

  • External nares: crusts or discharges
  • Nostrils: inflammation of the mucus membrane, septal deviations

MOUTH AND PHARYNX

  • Lips: redness, swelling, crusts, cyanosis, angular stomatitis
  • Odor of the mouth: foul smelling
  • Teeth: discoloration and dental caries
  • Mucous membrane and gums: ulceration and bleeding, swelling, pus formation
  • Tongue: pale, dry, lesions, sores, furrows, tongue tie, etc.
  • Throat and pharynx: enlarged tonsils, redness and pus

NECK

  • Lymph nodes: enlarged, palpable
  • Thyroid gland: enlarged
  • Range of motion: flexion, extension and rotation

CHEST

  • Thorax: shape, symmetry of expansion, posture
  • Breath sounds: sigh, swish, rustle, wheezing, rales, crepitations, pleural rub, etc
  • Heart: size and location, cardiac murmurs
  • Breasts: enlarged lymph nodes

ABDOMEN

  • Obstruction: skin rashes, scars, hernia, ascites, distention, pregnancy, etc
  • Auscultation: bowel sounds, fetal heart sounds
  • Palpation: liver margin, palpable spleen, tenderness at the appendix, inguinal hernias
  • Percussion: presence of gas, fluid or masses

Extremities: movement of joints, tremors, clumbing of fingers, ankle edema, varicose veins, reflexes, etc

Back: spinal bifida curves

GENITAL AND RECTUM

  • Inguinal lymph glands: enlarged, palpable
  • Patency of urinary meatus and rectum (in infants)
  • Descent of the testes
  • Vaginal discharges
  • Presence of sexually transmitted diseases
  • Hemorrhoids
  • Enlargement of the prostate gland
  • Pelvic masses

NEUROLOGICAL TESTS

  • Coordination tests
  • Reflexes
  • Equilibrium tests
  • Tests for sensations
  • Role of the nurse in the physical examination

VARIOUS PREPARATIONS FOR PHYSICAL EXAMINATION

PHYSICAL EXAMINATION

COMFORT DEVICES

BOWEL ELIMINATION

HEAD TO TOE PHYSICAL EXAMINATION – General status, Mental status, Height and Weight, Skin Conditions, Head and Face, Eye, Ears, Nose, Mouth and Pharnyx, Neck, Chest, Abdomen, Neurological Tests.
HEAD TO TOE PHYSICAL EXAMINATION – General status, Mental status, Height and Weight, Skin Conditions, Head and Face, Eye, Ears, Nose, Mouth and Pharnyx, Neck, Chest, Abdomen, Neurological Tests.

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