Mindanao State University – Iligan Institute of Technology Student: _________________________ Group: __________

Inclusive Dates of Duty: ______________________________

Maternal and Child Nursing Patient: __________________________ Room No.: _______

REVIEW OF SYSTEMS
Physical Examination

Vital Signs:
Temp: _________ RR: __________ Weight: ______________
PR: __________ BP: __________ Height: ______________

Chief Complaint/s: _________________________________________________________________ Impression/Diagnosis: _______________________________________

1. General (weight loss or gain;

fever, chills, night sweats; mood;
stage of development, race, sex;
signs of distress; position;
cooperative or not; state if irritable,
agitated or pleasant; etc.)

2. Head (headache, injury,

tenderness, etc.); Eyes (change in
visual fields, glasses, blurring,
diplopia, pain, loss of vision, tearing,
dry eyes, etc.); Ears (change in
hearing, tinnitus, discharge,
dizziness, etc.); Nose (allergies,
sinus problem, obstruction, polyps,
sneezing, epistaxis, etc.);Throat
(toothaches, loose teeth, bleeding
gums, mouth sores, hoarseness,
difficulty swallowing, etc.)
3. Integumentary System

4. Respiratory System
(chest pain, dyspnea, cough,
amount and color of sputum,
hemoptysis, etc.)
5.Cardiovascular System (chest
pain/ pressure/ tightness,
palpitations, orthopnea, paroxysmal
nocturnal dyspnea, shorntness of
breath, edema, claudication,
endurance, etc.)
6. Digestive System
(dysphagia, heartburn, ulcer, GERD,
indigestion, food intolerance,
diarrhea, constipation, abdominal
pain, blood in stool, black tarry
stools, changes in bowel habits,
reduced caliber of stools,
hemorrhoids, etc.)
7. Excretory System
(urgency, frequency, nocturia,
dysuria, hematuria, recurrent UTIs,
STD, incontinence, etc.)

8.Musculoskeletal System
(limitation in movement, stiffness,
joint pain, swelling or redness,
arthritis, muscle spasms, muscle
weakness, etc.)
9. Nervous System

10. Endocrine System

(heat/cold intolerance, weight
change, fatigue, polydipsia, polyuria,
polyphagia, changes in hair
distribution, etc.)
11. Reproductive System