Methods of Physical Examination

Methods of Physical Examination

Physical Examination

Physical Examination: A physical examination is an investigation of the body to determine its state of health. A physical examination involves the use of the techniques of inspection, palpation, percussion, auscultation, and smell. A complete examination includes a client’s height, weight, vital signs, and a head-to-toe examination of all body systems.

Articles used for physical Examination

Name of ArticlePurpose
ThermometerFor assessing the temperature
SphygmomanometerFor assessing the blood pressure
LaryngoscopeFor assessing the larynx
StethoscopeFor listening to the various body sounds
Weighing machineFor measuring the weight
OphthalmoscopeFor examination of the eye
FetoscopeFor listening to the fetal heart sounds
Tongue depressorFor visualization of mouth and throat
Nasal speculumFor examining the nostrils
Tuning forkFor assessing the hearing condition
Vaginal speculumFor examining female genital organs
FlashlightTo visualize any body part and to check pupil reaction
Percussion hammerFor testing reflexes
ProctoscopeFor examining the rectum
OtoscopeFor examining the ear
Pharyngeal retractorFor visualizing pharynx
Tape measureFor measuring height and various circumferences

Normal Physical Examination Findings in the Middle Adult

Body SystemAssessment Findings
IntegumentVery thin skin
Rough, flaky, dry skin
Scalp and hairExcessive generalized hair loss or patchy hair loss
Excessive scaliness
Head and NeckLarge, thick skull and facial bones
Asymmetry in the movement of head and neck
Drooping of one side of the face
EyesReduced peripheral vision
Asymmetric position of the light reflex
Drooping of the upper eyelid or ptosis
Redness or crusting around the eyelids
EarsDischarge of any kind
Reddened, swollen ear canals
Nose, sinuses, and
Nasal tenderness,
Occlusion of nostril
Swollen and pale pink or bluish-gray nasal mucosa
Sinuses tender to palpation or upon percussion
Asymmetric movement or loss of movement of the uvula
Tonsils red or enlarged
Thorax and lungsUnequal chest expansion
Unequal fremitus, hyper resonance, diminished or absent breath sounds
Adventitious lung sounds such as crackles and wheezes
Heart and vascular systemPulse inequality, weak pulses, bounding pulses, or variations in the strength of pulse from beat to beat.
Bradycardia or tachycardia
Hypertension or hypotension
Breast – femaleA recent increase in the size of one breast
Pigskin-like or orange-peel appearance
Redness or painful breasts
Breast – male abdomenSoft, fatty enlargement of breast tissue
Bruises, areas of local discoloration, purple discoloration, or pale, taut skin
Generalized abdominal distension
Hypoactive, hyperactive, decreased, or absent bowel sounds
Female genitaliaAsymmetric labia
Swelling, pain, or discharge from Bartholin’s glands
The decreased tone of the vaginal musculature
Cervical enlargement or projection into the vagina
Reddened areas or lesions in the vagina
Male genitaliaRashes, lesions, or lumps on the skin of the shaft of the penis.
Discharge from penis
Enlarged scrotal sac
Bulges that appear at the external inguinal ring or at the femoral canal when the client bears down
Muskuloskeletal systemUneven weight bearing
Decreased range of joint motion: swollen, red, or enlarged joint: painful joints
Decreased strength against resistance
Neurological systemLethargy
Inadequate motor responses
Abnormal sensory responses: inability to smell certain aromas, loss of visual fields, inability to feel and correctly identify facial stimuli, absent gag reflex

Urine Physical Examination

MeasurementNormal ValueInterpretation
pH4.6 – 8.0the pH of urine indicates the acid-base balance
ProteinNoneNormally protein is not present. But it is common in renal disease because of damage to the glomeruli and tubules that allow proteins to enter the urine
KetoneNoneIt is present in uncontrolled diabetes mellitus(ketonuria) due to the breakdown of fatty acids. The other conditions are starvation, dehydration, use of excessive aspirin
BloodNoneA positive test means the presence of RBCs, hemoglobin or myoglobin
Specific Gravity1.0053 – 1.030Increased in concentrated urine, decreased in diluted urine
Microscopic Examination
RBCsup to 2Damage to glomeruli or tubules, trauma, disease or surgery of urinary tract may lead to hematuria
WBCs 0 – 4Greater numbers indicate UTI
BacteriaNonePresence of bacteria Indicate UTI
CastsNoneIncreased numbers indicate calculi or renal alterations
CrystalsNonePresence of crystals indicate renal calculi or impaired food metabolism

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