SanPedroCollege

DavaoCity

PERFORMANCE CHECKLIST

PHYSICAL ASSESSMENT
Name:___________________________ Grade_________
Year & section____________________ Date__________

PHYSICAL HEALTH ASSESSMENT 2

1. Assessing the Thorax and Lungs

RATING
1. Assemble equipment and supplies: 5 4 3 2 1
*stethoscope
*Skin marker/pencil
*centimeter ruler
Assessment
2. Inspect the shape and symmetry of the thorax from the
posterior and lateral views.
3. Inspect spinal alignment for deformities.
Have the client to stand from a lateral position.
Observe the standing client from the rear. Have the
client bend forward at the waist and observe from
behind.
4. Palpate the posterior thorax.
For clients who have no respiratory complaints,
rapidly assess the temperature and integrity of all chest
skin.
For clients who do have respiratory complaints,
palpate all chest areas for bulges, tenderness or
abnormal movements. Avoid deep palpation for
painful areas especially if fractured rib is suspected.
5. Palpate the posterior chest for respiratory excursion.
Place the palms of both hands over the lower thorax,
with your thumbs adjacent to the spine and your
fingers stretched laterally. Ask the client to take deep
breath while you observe the movement of your hands
and any lag in movement.
6. Palpate the chest for vocal (tactile) fremitus, instruct
to say 1, 2, 3. Place the palmar surfaces of your
fingertips of the ulnar aspect of your hand or closed
fist on the posterior chest starting near the apex of the
lungs.
7. Ask the client to repeat such words as “blue moon” or
“one, two, three.”
8 Repeat the two steps moving your hands sequentially
to the base of the lungs.
9. Compare the fremitus on both lungs and between the
apex and the base of each lung either: 1) using one
hand and moving it from one side of the client to the
 corresponding area on the other side 2) using two
hands that are placed simultaneously on the
corresponding areas of each side of the chest.
10. Percuss the thorax.
11. Percuss for diaphragmatic excursion.
12. Auscultate the chest using the flat disc diaphragm of
the stethoscope. Warm the diaphragm slow deep
breath.
13. Uses the systematic zigzag procedure used in
percussion.
14. Ask the client to take slow, deep breaths through the
mouth. Listen at each point to the breath sounds during
a complete inspiration and expiration.
15. Compare findings at each point with the corresponding
point on the opposite side of the chest.
Anterior Thorax
16. Inspect breathing patterns.
17. Inspect the costal angle and the angle at which the ribs
enter the spine.
18. Palpate the anterior chest.
19. Palpate the anterior chest for respiratory excursion.
Place the palms of both palms of your hand on the
lower thorax with your fingers laterally along the
lower rib cage and your thumbs along the costal
margins.
Ask the client to take a deep breath while you observe
the movement of your hands.
20. Palpate tactile fremitus in the same manner as for the
posterior chest.
If the breasts are large and cannot be retracted
adequately for palpation this part of the examination is
usually omitted.
21. Percuss the anterior chest systematically.
Begin above the clavicles in the supraclavicular space
and proceed downward to the diaphragm.
22. Compare one side of the lung to the other.
23. Displace female breasts for proper examination.
24. Auscultate the trachea.
25. Auscultate the anterior chest.
Use the sequence used in percussion beginning over
the bronchi between the sternum and the clavicles.
26. Document the findings in the client’s record.
2. Assessing the Heart and the Central Vessels
1. Assemble equipment and supplies:
Posterior Thorax
1. Simultaneously inspect and palpate the precordium for
the presence of abnormal pulsations, lifts, or heaves.
Inspect and palpate the aortic and pulmonic areas,
observing them at an angle and to the side, to note for
the presence and absence of pulsations.
Inspect and palpate the tricuspid area for pulsations and
heaves or lifts
Inspect and palpate the apical area for pulsation.
Nothing its specified location (it may be displaced
laterally or lower) and diameter. If displaced laterally,
record the distance between the apex and the MCL in
centimeters.
Inspect and palpate the epigastric area at the base of the
sternum for abdominal aortic pulsations
2. Auscultate the heart in all four anatomic sites: aortic,
pulmonic, tricuspid, and apical (mitral).
Carotid Arteries
3. Palpate the carotid artery.
Use extreme caution
4. Auscultate the carotid artery.
Jugular Veins
5. Inspect the jugular veins distention.
The client is placed in a semi-Fowler’s position, with
the head supported on a small pillow.
6. The jugular distention is present, assess the jugular
venous pressure (JVP).
Assemble equipment and supplies: millimeter ruler,
examination gloves and magnifying glass.
7. Locate the highest visible point of distention of the
internal jugular vein.
8. Document pertinent findings in the patient’s chart.

13. Assessing the Peripheral Vascular System

Peripheral Pulses
1. Palpate the peripheral pulses (except the carotid pulse)
on both sides of the client’s body individually,
simultaneously, and systematically to determine the
symmetry of pulse volume.
Peripheral Veins
2. Inspect the peripheral veins in the arms and legs for the
presence and/or appearance of superficial veins when
limbs are dependent and when limbs are elevated.
3. Assess the peripheral leg veins for signs of phlebitis.
Peripheral Perfusion
4. Inspect the skin of the hands and feet for color,
temperature, edema and skin changes.
5. Assess the adequacy of arterial flow if arterial
insufficiency is suspected.
6. Document findings in the client’s record.
14. Assessing the Breast and Axillae
1. Assemble equipment.
• Centimeter ruler
Assessment
3. Palpate the carotid artery.
Use extreme caution
4. Auscultate the carotid artery.
Jugular Veins
5. Inspect the jugular veins distention.
The client is placed in a semi-Fowler’s position, with
the head supported on a small pillow.
6. The jugular distention is present, assess the jugular
venous pressure (JVP).
Assemble equipment and supplies: millimeter ruler,
examination gloves and magnifying glass.
7. Locate the highest visible point of distention of the
internal jugular vein.
8. Document pertinent findings in the patient’s chart.
13. Assessing the Peripheral Vascular System

Peripheral Pulses
1. Palpate the peripheral pulses (except the carotid pulse)
on both sides of the client’s body individually,
simultaneously, and systematically to determine the
symmetry of pulse volume.

Peripheral Veins
2. Inspect the peripheral veins in the arms and legs for the
presence and/or appearance of superficial veins when
limbs are dependent and when limbs are elevated.
3. Assess the peripheral leg veins for signs of phlebitis.
Peripheral Perfusion
4. Inspect the skin of the hands and feet for color,
temperature, edema and skin changes.
5. Assess the adequacy of arterial flow if arterial
insufficiency is suspected.
6. Document findings in the client’s record.
1. Assessing the Breast and Axillae
1. Assemble equipment.
• Centimeter ruler
Assessment
2. Inspect the breast for size, symmetry, and contour or
shape while the client is in a sitting position.
3. Inspect the skin of the breast for localized
discolorations or hyperpigmentation, retraction or
dimpling, localized hypervascular areas, swelling or
edema.
4. Emphasize any retraction by having the client:
 • Raise the arms above the head
• Push the hands together, with elbows flexed
• Press the hands down on the hips
5. Inspect the areola area for size, shape, symmetry, color,
surface characteristics, and any masses or lesions.
6. Inspect the nipples for size, shape, symmetry, color,
surface characteristics, and any masses or lesions.
7. Palpate the axillary, subclavicular, and supraclavicular
lymphnodes.

8.
The client is seated with the arms abducted and
supported on the nurse’s forearm
9. Use the flat surfaces of all fingertips to palpate the four
areas of the axilla:
• The edge of the greater pectoral muscle along the
anterior axillary line.
10. Palpate the breast for masses, tenderness and any
discharge from the nipples.
Palpate the areola and the nipples for masses.
11. Compress each nipple to determine the presence of any
discharge. If discharge is present, milk the breast along
its radius to identify the discharge-producing lobe.
12. Assess any discharge for amount, color, consistency
and odor.
13. Note any tenderness on palpation.
14. Document pertinent findings in the client’s record.
2. Assessing the Abdomen
Equipment:
1. Assemble equipment and supplies:
* Examine light
* Tape measure (metal/unstretchable cloth)
* Water – soluble skin marking pencil
* Stethoscope
2. Ask client to urinate, empty bladder makes assessment
more comfortable.
3. Assist the client to a supine position with the arms
placed comfortably at the sides.
4. Place small pillows beneath the knees and the head to
reduce tension in the abdominal muscles. Expose only
the client’s abdomen from chest line to the pubic area
to avoid chilling and shivering, which can tense the
abdominal muscles.
Assessment
5. Inspect the abdomen for skin integrity
6. Inspect the abdomen for contour and symmetry.
7. Observe the abdominal contour while standing at the
client’s side when the client is supine.
8. Ask the client to take a deep breath and to hold it.
9. Assess the symmetry of contour while standing at the
foot of the bed.
10. If distention is present, measure the abdominal girth by
placing a tape around the abdomen at the level of the
umbilicus.
11. Observe abdominal movements associated with
respiration, peristalsis or aortic pulsations.
12. Observe the vascular pattern.

Auscultation of the abdomen

13. Auscultate the abdomen for bowel sounds, vascular
sounds and peritoneal friction rubs.
Percussion of the liver
14. Percuss the liver to determine its size.
Palpation of the Abdomen
15. Perform light palpation first to deter areas of
tenderness and/or muscle guarding.
16. Systematically explore all four quadrants.
17. Perform deep palpation over all four quadrants.
Palpation of the Liver
18. Palpate the liver to detect enlargement and tenderness,
blow R coastal margin.
Palpation of the Bladder
19. Palpate the area above the pubic symphysis if the
client’s history indicates possible urinary retention.
20. Document pertinent findings in the client’s record.
Assessing the Female Genitals and Inguinal Area
1. Assemble equipment and supplies:
*examination gloves
*Drape
*supplemental lightning
Assessment
2. Inspect the distribution, amount, and characteristics of
pubic hair.
3. Inspect the skin of the pubic area for parasites,
inflammation, swelling and lesions. To assess pubic
skin adequately, separate the labia majora and labia
minora.
4. Inspect the clitoris, urethral orifice, and vaginal orifice
when separating the labia majora.
5. Palpate the inguinal lymphnodes.
6. Document findings in the client’s record.
19. Assessing the Male Genitals and Inguinal Area
1. Assemble equipment and supplies:
• Examination gloves
Pubic Hair
2. Inspect the distribution, amount, and characteristics
of pubic hair.
Penis
3. Inspect the penile shaft and glans penis for lesions,
nodules, swellings and inflammation.
4. Inspect the urethral meatus for swelling,
inflammation, and discharge.

Compress or ask the client to compress the glans

slightly to open the urethral meatus to inspect it for
discharge. If the client has reported a discharge, instruct
the client to strip the penis from the base to the urethra.
5. Palpate the penis for tenderness, thickening, and
nodules. Use your thumb and first two fingers.
Scrotum
6. Inspect the scrotum for appearance, general size, and
symmetry.
To facilitate inspection of the scrotum during a physical
examination, ask the client to hold the penis out of the
way.
Inspect all skin surfaces by spreading the rugaeted
surface of the skin and lifting the scrotum as needed to
observe posterior surfaces.
7. Palpate the scrotum to assess status of underlying
testes, epididymis, and spermatic cord. Palpate both
testes simultaneously for comparative purposes.
Inguinal Area
8. Inspect both inguinal areas for bulges while the client
is standing, if possible.
The client remains at rest.
Next, have the client hold his breath and strain or bear
down, as though having a bowel movement.
9. Palpate hernias.
10. Document findings in the client record.
20. Assessing the Rectum and Anus
1. Position the client.
In adults, a left lateral or Sims position with the
upper leg accurately flexed is required for the
examination.
For females: a dorsal recumbent position with hips
externally rotated and knees flexed or lithotomy
position may be used.
For males: A standing position while the client bends
over the examining table may also be used.
Assessment
2. Inspect the anus and surrounding tissue for color,
integrity, and skin lesions.
Then ask the client to bear down as though defecating.
 Describe the location of all abnormal findings in terms
of a clock, with the 12 o’clock position toward the
pubic symphysis.
3. Palpate the rectum for anal sphincter tonicity, nodules,
masses, and tenderness.
4. On withdrawing the finger from the rectum and anus,
observe it for feces.

5. Document findings in the client.

Comments:

______________________________________ ________________
Student’s signature over Printed Name Date

______________________________________ ________________
Clinical Instructor’s signature Date
 San Pedro College
DavaoCity

PERFORMANCE CHECKLIST

PHYSICAL ASSESSMENT
Name:_______________________________ Grade_________
Year & section________________________ Date__________

PHYSICAL ASSESSMENT 3

RATING
5 4 3 2 1
Assessing the Musculoskeletal System
1. Inspect the muscle for size. Measure the muscle with
a tape
2. Compare each muscle on one side of the body to the
same muscle on the other side for any apparent
discrepancies.
3. Inspect the muscle and tendons for contractures and
fasciculation.
4. Inspect any tremors of the hands and arms by having
the client hold the arms out in front of the body.
5. Palpate muscles at rest to determine muscle tonicity.
6. Palpate muscle while client is doing active range of
motion. Check flaccidity, spasticity, and smoothness
of movement. (Flexion and extension movement)
7. Palpate muscle while the client is doing passive range
of motion.
8. Test muscle strength. Compare the right side with left
side.
Grade Description
0 No muscular contraction detected
1 A barely detectable trace of contraction
2 Active movement with gravity
eliminated
3 Active movement against gravity
4 Active movement against gravity and
some resistance
5 Active movement against full
resistance
Bones
1. Inspect the skeleton for normal structure and
deformities.
2. Palpate the bone to locate any areas of edema or
tenderness.
Joints
1. Inspect the joint for swelling.
2. Palpate each joint for tenderness, swelling, crepitation,
and presence of nodules.
3. Assess joint for range of motion, smoothness of
movement.
4. Document pertinent findings in the client’s record.
Neurologic Assessment
1. Determine the client’s orientation to time, place and
person by tactful questioning.
2. Determine client’s Level of Consciousness
(RLS/GCS). Make use of the Neuro Assessment
Graphic Sheet.
3. Assess the Cranial Nerves
a. Cranial Nerve I- Olfactory
Ask the client to close eyes and identify different mild
aromas, such as coffee, alcohol, vanilla, alcohol.
b. Cranial Nerve II – Optic
Ask client to read Snellen’s chart and check visual
fields by confrontation .
c. Cranial Nerve III- Oculomotor
Assess six ocular movements and pupil reaction.
d. Cranial Nerve IV- Trochlear; 6-Abducens
Assess six ocular movements. CN 6 assess ability to
gaze laterally.
e. Cranial Nerve V – Trigeminal
While the client looks upward, lightly touch lateral
sclera of eye to elicit BLINK reflex. To test light
sensation, have client close eyes, and wipe a wisp
of cotton over the client’s forehead and paranasal
sinuses. Use blunt and sharp ends of safety pin for
deep sensation over the same area.
f. Cranial Nerve VII- Facial
Ask client to smile, raise the eyebrows, frown, puff out
his cheeks, close his eyes tightly (against attempt to
open them).
g. Cranial Nerve VIII- Acoustic (Vestibulocochlear)
Assess client’s ability to hear spoken words, and
vibrations from tuning fork (Apply Weber and Rinne
Test.).
h. Cranial Nerve IX – Glossopharyngeal
Depress the tongue with a tongue blade, and note
pharyngeal movement as the person says “ahhh” or
yawns. Touch the posterior pharyngeal wall with
tongue blade and note the gag reflex. Apply tastes on
posterior tongue for identification.
i. Cranial Nerve X- Vagus
Assess with CN IX; assess client’s speech for
hoarseness.
j. Cranial Nerve- XI - Spinal Accessory
Ask the client to shrug shoulders against resistance
from your hands and turn his head to side against
resistance from your hand. Repeat for the other side.
k. Cranial Nerve X- Hypoglossal
 Ask client to protrude his tongue at midline, then move
it side to side.
Reflexes
1. Biceps Reflex – test the spinal cord level C5-C6
Partially flex the client’s arm at the elbow, and rest the
forearm over the thighs, placing the palm of the hand
down. Place the thumb of your nondominant hand
horizontally over the biceps tendon.
Deliver a blow (slight downward thrust) with the
percussion hammer to your thumb. Observe the
normal slight flexion of the elbow, and feel the
biceps’s contraction through your thumb.
2. Triceps Reflex – test the spinal cord level C7, C8
Flex the client’s arm at the elbow level, and support it
in the palm of your nondominant hand. Palpate the
triceps tendon about 2-5 cm (1-2 in) above the elbow.
Deliver a blow with the percussion hammer directly to
the tendon. Observe for the normal slight extension of
the elbow.
3. Brachioradialis Reflex – tests the spinal cord level C3,
C6
Rest the client’s arm in a relaxed position on your
forearm or on the client’s own leg.
Deliver a blow with the percussion hammer directly on
the radius 2-5 cm (1-2 in) above the bony prominence
on the thumb side of the wrist. Observe the normal
flexion and supination of the forearm. The fingers of
the hand may also extend slightly.
4. Patellar Reflex – test the spinal cord level L2,L3,L4
Ask the client to sit on the edge of examining table so
that his legs hang freely.
Locate the patellar tendon directly below the patella.
Deliver a blow with the percussion hammer directly to
the tendon. Observe the normal extension or kicking
out of leg as the quadriceps muscle contracts
5. Achilles Reflex – tests the spinal cord level S1;S2.
With the client in the same position as for the patellar
reflex, slightly dorsiflex the client’s ankle by
supporting the foot lightly in the hand.
Deliver a blow with the percussion hammer directly to
the Achilles tendon just above the heel. Observe and
feel the normal plantar flexion (downward jerk) of the
foot.
6. Plantar (Babinski’s) Reflex –
Use modearately sharp object, such as the handle of
percussion hammer.
Stroke the lateral border of the sole of the client’s foot,
starting at the heel, continuing to the ball of the foot,
and then proceeding across the ball of the foot toward
the big toe. Observe for the response. Normally, in
adult all five toes bend downward.
Motor Function
1. Gross Motor and Balance Test
a. Walking Gait
Ask the client to walk across the room and back,
and assess the client’s gait.
b. Romberg’s test
Ask the client to stand with feet together and arms
resting at the sides, first with eyes open , then closed
or 20 to 30 seconds without support.
c. Standing with one foot with eyes closed
Ask the client to close his eyes and stand on one foot,
then the other. Stand close to the client during the test.
d. Heel-Toe Walking
Ask the client to walk a straight line, placing the heel
of one foot directly in front of the toes and then on the
heels.
e. Toe or heel Walking
Ask the client to walk several steps on the toes and
then on the heels.
2. Fine motor Test for Upper Extremities
a. Finger to Nose Test
Ask the client to abduct and extend the arms at
shoulder height and rapidly touch the nose alternately
with one index finger and then the other. Have the
client repeat the test with the eyes closed if the test is
performed easily.

b. Alternating Supination and pronation of hands and

Knees
Ask the client to pat both knees with the palms of both
hands and then with the backs of the hands alternately
at an ever-increasing rate.
c. Finger to Nose and to the Nurse’s finger
Ask the client to touch the nose and then your index
finger held at a distance at about 45cm (18 in) at a
rapid and increasing rate.
d. Fingers to Fingers
Ask the client to spread the arms broadly at shoulder
height and then bring the fingers together at the
midline, first with the eyes open and then closed, first
slowly and then rapidly.
e. Fingers to thumb
Ask the client to touch each finger of one hand to the
thumb of the same hand as rapidly as possible.
3. Fine Motor test for the lower extremities
Ask the client to lie supine and to perform these test:
a. Heel Down opposite Shin
Ask the client to place the heel of one foot just below
the opposite knee and run the heel down the shin to the
 foot. Repeat with the other foot. The client may also
use a sitting position for this test.
b. Toe or Ball of Foot to the Nurse’s finger
Ask the client to touch your finger with the large toe
of each foot.
4. Light-touch Sensation
a. Compare the light touch sensation of symmetric
areas of the body.
b. Ask the client to close the eyes and to respond by
saying “yes” or “now” whenever the client feels the
cotton wisp touches his skin.
c. With a wisp of cotton, lightly touch specific spot and
then the same spot on the other side of the body.
d. Test areas on the forehead, cheek, hand, lower arm,
abdomen, foot, and lower leg. Check a specific
area of the limb first.
e. Ask the client to point to the spot where the touch
was felt.
e. If areas of sensory dysfunction are found,
determine the boundaries of sensation by testing
responses about every 2.5cm (1 in) in the area.
Make a sketch of the sensory loss area for
recording purposes.

5. Pain Sensation
Equipment: Broken tongue depressor
a. Assess pain sensation as follows:
b. Ask the client to close his eyes and to say “sharp”,
“dull”, “don’t know” when the sharp or dull end of the
broken tongue depressor is felt.
Alternately, use the sharp and dull end of the sterile
pin or needle to lightly prick designated anatomic
areas at random. The face is not tested in this manner.
Allow at least 2 seconds between each test.
6. Temperature Sensation
Touch skin areas with test tubes filled with hot or cold
water.
Have the client respond saying “hot”, “cold” or “don’t
know”.
7. Position or Kinesthetic Sensation
Commonly, the middle fingers and the large toes are
tested for the kinesthetic sensation.
To test the fingers, support the client’s arm with one
hand and hold the client’s palm in the other. To test the
toes, place the client’s heels on the examining table.
Ask the client to close his eyes.
Grasp a middle finger or a big toe firmly between your
thumb and index finger and exert the same pressure on
both sides of the finger or toe while moving it.
 Use a series of brisk up-and-down movements before
bringing the finger or toe suddenly to rest in one of the
three positions.
Moving the finger of toe until it is up, down, or
straight out, and ask the client to identify the position.
8. Tactile Sensation
For the entire test, the client’s eyes need to be closed.
a. One-and-Two point Discrimination
Alternatively stimulate the skin with two pins
simultaneously and then with one pin. Ask
whether the client feels one or two pinpricks.
b. Stereognosis
Place familiar objects- such as key, paper clip, or
coin- in the client’s hand, and ask the client to
identify them.
If the client has a motor impairment of the hand
and is unable to manipulate an object, write a
number or letter on the client’s palm, using a blunt
instrument, and ask the client to identify it.
c. Extinction Phenomenon
Simultaneously stimulate two symmetric areas of
the body, such as the thighs, the cheeks, or the
hands.
9. Document findings in the client’s chart.

Comments

_______________________________ _____________
Student’s signature over Printed Name Date

_______________________________ _____________
Clinical Instructor’s signature Date