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  • Physical Assessment Form 1

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    pauchanmnl
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    This physical assessment form collects information on a patient's vital signs, including temperature, blood pressure, pulse, respiratory rate, and oxygen saturation. It also documents the patient's pain levels and locations, as well as notes from assessments of the head, eyes, ears, nose, throat, and mouth. Specific items examined include pupil size and reaction, vision, hearing, nasal drainage and blockages, sense of smell, throat mucosa, oral hygiene, swallowing, and lymph nodes. Special notes sections are included for additional information.

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    This physical assessment form collects information on a patient's vital signs, including temperature, blood pressure, pulse, respiratory rate, and oxygen saturation. It also documents the patient's pain levels and locations, as well as notes from assessments of the head, eyes, ears, nose, throat, and mouth. Specific items examined include pupil size and reaction, vision, hearing, nasal drainage and blockages, sense of smell, throat mucosa, oral hygiene, swallowing, and lymph nodes. Special notes sections are included for additional information.

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    © All Rights Reserved
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    8 views1 page

    Physical Assessment Form 1

    Uploaded by

    pauchanmnl
    This physical assessment form collects information on a patient's vital signs, including temperature, blood pressure, pulse, respiratory rate, and oxygen saturation. It also documents the patient's pain levels and locations, as well as notes from assessments of the head, eyes, ears, nose, throat, and mouth. Specific items examined include pupil size and reaction, vision, hearing, nasal drainage and blockages, sense of smell, throat mucosa, oral hygiene, swallowing, and lymph nodes. Special notes sections are included for additional information.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 1

    Physical Assessment Form

    Name: _______________________
    Date: __________________
    Vital Signs
    1. Temperature: ______ 97.0 99.5 Site: __________
    2. BP: ______ 120 / 80 Left Arm Right

    Arm
    Other: _________ Position:_______
    3. Pulse: ______ reg rate reg

    ryth irreg

    weak 1+ steady

    2+ strong

    3+ bounding

    4+
    4. Resp. Rate: ______
    even/reg irreg

    labored

    moderate

    shallow

    deep

    apnea

    5. O2 Sat.: ______ 93% - 100%


    6. Pain: ______ Location: ______ Description: ____________________________
    Special Notes: ___________________________________________________________
    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _________________________________
    HEENT
    1. Eyes
    a. Pupils
    b.

    Vision

    PERRLA equal

    round

    raxn

    to light accom

    convergence

    Size: _____mm

    nearsighted

    farsighted

    glasses

    contacts

    2. Ears
    a. Hearing aids
    left ear right

    ear
    none

    b. Pain/Wax build up
    left ear right

    ear
    none

    c. Comprehension
    yes no

    3. Nose
    a. Drainage
    yes no

    b. Blockages yes no

    c. Sense of Smell
    yes no

    d. Congestion yes no

    e. Mucous Membranes moist pink

    pale

    pallor

    4. Throat/Mouth
    a. Mucous Membranes
    moist pink

    pale

    pallor

    b. Oral Hygiene

    teeth
    dentures good poor

    c. Swallowing easy

    difficult painful

    d. Lymph nodes
    normal enlarged

    Special Notes: ___________________________________________________________


    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _________________________________

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