physical

examination
HEAD

Parts
• Skull & Face
Techniques • Eyes & Vision
Inspection • Ears and Hearing
Palpation • Nose and Sinuses
Auscultation • Mouth and Oropharynx
 SKULL AND
FACE Deviation
Characteristics Norma
from
l
normal
Rounded (normocephalic) Lack of symmetry
Symmetrical Increased skull
Size, shape
Smooth skull contour. size
and
symmetry
Smooth Sebaceous cysts
uniform Local deformities
Nodules ,masse
consistency from trauma
s and Absence of nodules Masses and nodules
depressions or masses
 SKULL AND
FACE Deviation
Characteristics Norma
from
l
normal
Increased facial hair
Symmetric or slightly Thinning of
asymmetric facial eyebrows
Facial features; palpebral Asymmetric
features fissures equal in features;
size ;symmetric Exophthalmos;
nasolabial folds. myxedema facies ;
moon face
Eyes for Periorbital
No
edema and edema Sunken
edema
hollowness eyes
 SKULL AND FACE
Deviation
Characteristics Norma
from
l
normal
Asymmetric
facial movements
Drooping of
Symmetry of Symmetric facial lower eyelid and
facial movements mouth
movements Involuntary
facial
movements
 EYES AND VISION

Equipments
Assessment of eye • Cotton tip
includes, applicator
•External eye structures • Gauze square
•Visual fields • Clean gloves
•Extra ocular muscle • Millimeter ruler
tests • Penlight
• Snellen’s or E chart
•Visual acuity
Eye
brows
• Hair distribution and
alignment
• Symmetry
• Skin quality
• Movement

Eye lashes
• Evenness of distribution
• Direction of curl

Eye lids
• Surface characteristics
• Position in relation to the cornea
• Ability to blink and frequency o f
blinking
Bulbar conjunctiva and palpebral
•conjunctiva
Color
• Texture
• Presence of lesions

Lacrimal gland , lacrimal sac

Cornea
• Clarity and texture
• Perform corneal sensitivity test
Anterior
chamber
• Transparency
• Depth

Pupils
• Color/shape/symmetry of size
• PERRLA (pupils are round and
react to light and
Visual fields
 Visual fields
Normal Deviation from normal
• When looking straight • Visual field smaller than
ahead ,client can see the normal (possible
objects in the periphery glaucoma)
• One half vision in one
or both eyes (possible
nerve damage)
Extra ocular muscle tests
Extra ocular muscle tests
 Extra ocular muscle tests
Normal Deviation from normal
• Both eyes • Eye movements not
coordinated coordinated or
parellel.
,move in • Strabismus (cross eye):
unison ,with parallel abnormal alignment of the
alignment eyes; the condition of
having a squint.
• Nystagmus : rapid
involuntary movements of
the eyes.
Visual acuity

Snellen’s chart
 Visual acuity
Normal Deviation from normal
• NEAR VISION:-Able to • Difficulty reading
read news print or a newsprint unless due to
magazine
aging process.
• DISTANT VISIO:- (Snellen’s
chart) 20/20 vision on
• Denominator of 40 or
Snellen’s- type chart more on Snellen-type
chart
If the client is unable to see even the top with
line of thecorrective
snellen type
chart lenses.
perform functional vision tests
 light perception
 Hand movements (H/F)
 Counting fingers(C/F)
 Refractive errors
Myopia
• Nearsightedness

Hyperopia
• Farsightedness

Presbyopia
• Loss of elasticity of the lens and thus loss of ability
to see close objects

Astigmatism
• An uneven curvature of the cornea that prevents horizontal
and vertical rays from focusing on the retina
 Inflammation
Conjunctivitis
• Inflammation of the bulbar and palpebral
conjunctiva

Dacryocystitis
• Inflammation of the Lacrimal sac

Hordeolum (sty)
• Redness swelling and tenderness of the hair
follicle and gland that empty at the edge of the
eye lids
Iritis
Contusions or
•hematomas
“Black eyes” resulting from injury

Cataracts
• Opacity of lens and its capsule

Glaucoma
• A disturbance in the circulation of aqueous
fluid which causes an increase in intra ocular
pressure.
 EA
R
Techniques
•Inspection
•Palpation

Assessment includes,
• Auricle Equipment
• External ear canal Otoscope with
• Tympanic several sizes of ear
membrane specula
 Auricle
(Inspection)
colo symmetry Positio
of size
r n
Normal Normal Normal
• Same as • symmetrical • Auricle
facial skin aligned with
outer canthus
of eye about
10 degree from
Deviation Deviation vertical
• Cyanosis • Asymmetry Deviation
• Pallor • Low set ears
• Excessive (down
redness syndrome)
 Auricle (Palpation)
• Texture elasticity and areas of
tenderness

Norma Deviatio
l n
• Mobile • Lesions
firm and • Flaky ,scal
non tender y skin
• Pinna • Tenderness
recoils after
it is folded
External ear and tympanic membrane

Otoscop
e
 EXTERNAL EAR AND TYMPANIC
MEMBRANE
Characteristics Normal Deviation from
normal
External ear Distal third contains Redness and
canal hair follicles and discharge Scaling
Cerume glands
Dry cerumen, Excessive
n grayish tan cerumen
color ;sticky wet obstructing canal
cerumen in various
Tympanic membrane shades of brown
Pearly gray Pink to red ,some
(color, and gloss) color, opacity ,yellow
semitransparent amber, White
Blue or deep
red Dull
 Gross hearing acuity tests
• Assess clients response to normal voice
tones
• Watch tick test
• Tuning fork tests
– Weber’s test
– Rinne test
Weber’s Rinne
test Normal test Normal
• Sound is heard • AC>BC
in both ears or • Positive
is localized at
the centre of the Rinne
head (Weber
negative) Deviation
• BC>AC
Deviation • BC=AC
• Bone • Negative
conductive Rinne
hearing loss
• Sensory neural
disturbances
 NOSE AND SINUSES

Assessment includes,
 Nose and nasal
cavities
 Facial sinuses
Techniques
 Inspection
Equipment
• Nasal speculum
 Palpation
• Flashlight/
penlight
 NOSE
• Inspect for nose for any deviations in
 Shape, size, color and flaring or discharge from the
nares.
• Lightly palpate the external nose for
 Tenderness, masses and displacement of bone and
cartilage.
• Determine patency of both nasal cavities
• Inspect the nasal cavities using nasal speculum
 Observe mucosa for redness , swelling,
growths, and discharges.
 SINUSES
• Palpate the maxillary and frontal sinuses for
tenderness
 MOUTH AND OROPHARYNX
Techniques
Assessment include • Inspection
 Lips and Buccal • Palpation
mucosa
 Teeth and Gums
 Tongue / floor of Equipments
mouth  Clean gloves
 Salivary glands  Tongue depressor
 Gauze pads
 Palates and uvula
 Penlight
 Oropharynx and
tonsils
 Lips and buccal mucosa
• Inspect outer lips for
– Symmetry ,contour, color and texture, ability to purse
lips
 Normal
• Uniform pink color & soft ,moist and smooth texture
• Symmetry of contour
• Able to purse lips
 Deviation from normal
• Pallor ,cyanosis
• Blisters, swelling, scaling
• Inability to purse lips
 Lips and buccal mucosa
• Inspect and palpate inner lips and buccal mucosa
for
– Color , moisture, texture and presence of lesions
 Normal
• Uniform pink color & soft ,moist, smooth , glistening and
elastic texture.
 Deviation from normal
• Pallor; leukoplakia (white patches) , red, bleeding
• Excessive dryness
• Mucosal cysts ;irritation from dentures , abrasions,
ulceraions
 Teeth and gums
 Normal
• 32 adult teeth
• Smooth, white, shiny tooth enamel
• Pink gums
• Moist firm texture to gums
• No retraction of gums
 Deviation from normal
• Missing teeth ;ill fitting dentures
• Brown or black discoloration of the enamel (dental caries)
• Excessively red gums
• Spongy texture ; bleeding; tenderness
• Receding; atrophied gums ; swelling that partially covers the
teeth
 Tongue/ floor of the mouth
 Inspect the surface of the tongue for
• Position, color, and texture.
 Normal
• Central position
• Pink color
• Smooth, lateral margins ; or no lesions
• Raised papillae ( taste buds)
 Deviation from normal
• Deviated from centre
• Smooth red tongue
• Dry, furry tongue (fluid deficit) , white coating (yeast
infection)
• Nodules , ulcerations, discolorations and areas of tenderness
 Tongue/ floor of the mouth
• Inspect the tongue movement
• Insect the base of the tongue the mouth floor and
frenulum
• Palpate the tongue and floor of the mouth
 Normal
• Moves freely no tenderness
• Smooth tongue with prominent veins
• Smooth , no palpable nodules
 Deviation from normal
• Swelling and ulceration
 Salivary glands
• Inspect salivary duct openings
for
– swelling or redness
 Normal
• Same as color of buccal
mucosa and floor of the
mouth
 Deviation from normal
• Inflammation
(redness and swelling)
 Palates and uvula
• Inspect the hard and soft palate for the
– Color , shape ,texture and presence of bony
prominences
• Inspect the uvula for
– Position and mobility
Oropharynx and tonsils
 Oropharynx and tonsils
• Inspect the Oropharynx for the
– Color and texture
 Normal : Pink and smooth posterior wall.
 Deviation from normal : Reddened or edematous,
presence of lesions.
• Inspect the tonsils
– Color, discharge, and size
 Normal : Pink color and smooth texture, no discharge,
normal size.
 Deviation from normal :Inflamed , presence of discharge,
swollen.
NECK

Assessment includes, Techniques

Sternocleidomastoid
muscle

Trapezius muscle
 Neck muscles
• Inspect the neck muscles
• Observe head movements
– Move chin to the chest (sternocleidomastoid)
– Move the head so that the ear is moved toward the
shoulder
on
each side (sternocleidomastoid)
– Turn the head to the right and to the left
(sternocleidomastoid)
– Move head back so that the chin points upward
(Trapezius)
 Lymph nodes
• Palpate the entire lymph node for
enlargement
Trachea
Trachea
Palpate the trachea
for lateral deviation
• Normal :
Central placement
in midline of neck
• Deviation
from normal:
Deviation to one side
(neck tumor, thyroid
or lymph node
enlargement)
 Thyroid gland
 Inspect the thyroid gland
 Normal :
Not visible on inspection
 Deviation from
normal : Local
enlargement
 Thyroid gland
 Palpate the thyroid gland
for smoothness note any
areas of enlargement, masses
and nodules.
 Posterior approach
 Anterior approach
 Normal :
Lobes may not be palpated
 Deviation from
normal: Solitary nodules
 Thyroid gland
 If enlargement of the gland is suspected , auscultate
over the thyroid area for bruit (a soft rushing sound
created by turbulent blood flow)
 “Lets have a brake”

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