Methods of 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 Article | Purpose |
| Thermometer | For assessing the temperature |
| Sphygmomanometer | For assessing the blood pressure |
| Laryngoscope | For assessing the larynx |
| Stethoscope | For listening to the various body sounds |
| Weighing machine | For measuring the weight |
| Ophthalmoscope | For examination of the eye |
| Fetoscope | For listening to the fetal heart sounds |
| Tongue depressor | For visualization of mouth and throat |
| Nasal speculum | For examining the nostrils |
| Tuning fork | For assessing the hearing condition |
| Vaginal speculum | For examining female genital organs |
| Flashlight | To visualize any body part and to check pupil reaction |
| Percussion hammer | For testing reflexes |
| Proctoscope | For examining the rectum |
| Otoscope | For examining the ear |
| Pharyngeal retractor | For visualizing pharynx |
| Tape measure | For measuring height and various circumferences |
Normal Physical Examination Findings in the Middle Adult
| Body System | Assessment Findings |
| Integument | Very thin skin Rough, flaky, dry skin lesion |
| Scalp and hair | Excessive generalized hair loss or patchy hair loss Excessive scaliness |
| Head and Neck | Large, thick skull and facial bones Asymmetry in the movement of head and neck Drooping of one side of the face |
| Eyes | Reduced peripheral vision Asymmetric position of the light reflex Drooping of the upper eyelid or ptosis Redness or crusting around the eyelids |
| Ears | Discharge of any kind Reddened, swollen ear canals |
| Nose, sinuses, and throat | 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 lungs | Unequal chest expansion Unequal fremitus, hyper resonance, diminished or absent breath sounds Adventitious lung sounds such as crackles and wheezes |
| Heart and vascular system | Pulse inequality, weak pulses, bounding pulses, or variations in the strength of pulse from beat to beat. Bradycardia or tachycardia Hypertension or hypotension |
| Breast – female | A recent increase in the size of one breast Pigskin-like or orange-peel appearance Redness or painful breasts |
| Breast – male abdomen | Soft, 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 genitalia | Asymmetric 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 genitalia | Rashes, 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 system | Uneven weight bearing Decreased range of joint motion: swollen, red, or enlarged joint: painful joints Decreased strength against resistance |
| Neurological system | Lethargy 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
| Measurement | Normal Value | Interpretation |
| pH | 4.6 – 8.0 | the pH of urine indicates the acid-base balance |
| Protein | None | Normally 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 |
| Ketone | None | It is present in uncontrolled diabetes mellitus(ketonuria) due to the breakdown of fatty acids. The other conditions are starvation, dehydration, use of excessive aspirin |
| Blood | None | A positive test means the presence of RBCs, hemoglobin or myoglobin |
| Specific Gravity | 1.0053 – 1.030 | Increased in concentrated urine, decreased in diluted urine |
| Microscopic Examination | ||
| RBCs | up to 2 | Damage to glomeruli or tubules, trauma, disease or surgery of urinary tract may lead to hematuria |
| WBCs | 0 – 4 | Greater numbers indicate UTI |
| Bacteria | None | Presence of bacteria Indicate UTI |
| Casts | None | Increased numbers indicate calculi or renal alterations |
| Crystals | None | Presence of crystals indicate renal calculi or impaired food metabolism |
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