Health examination

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DEFINITION

• Health examination• Health examination is the systematic

assessment of human body which involves the use of one’s senses to determine the general physical and mental conditions of the body

Physical examination

• Physical examination is defined as a complete assessment of a patient’s 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

EQUIPMENTS

• STETHOSCOPE

OPHTHALMOSCOPE

OTOSCOPE

SNELLEN CHART

NASAL SPECULUM

VAGINAL SPECULUM

TUNING FORK

PERCUSSION HARMER

SPHYGMOMANOMETER

POSITIONING• Sitting/fowler’s

STANDING

SUPINE AND PRONE

DORSAL RECUMBENT

Sim’s

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 patient’s chest• Square drum containing test tube, gauze

piece, cotton swab, specimen bottle, swabsticks

• Gloves• lubricant

ARTICLES REQUIRED

• Torch• Ophthalmoscope• Snellen’s 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• Snellan’s 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 (beau’s 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• WEBER’S 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• Romberg’s 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

• ALLEN’S TEST• BUERGER’S TEST• CAPILLARY REFILL• HOMAN’S SIGN• PALPATE PERIPHERAL PULSES

DOCUMENTATION OF DATA

AFTER CARE OF THE PATIENT

AFTER CARE OF ARTICLES