CENTRAL PHILIPPINE UNIVERSITY

COLLEGE OF NURSING
JARO, ILOILO CITY
(The First Nursing School of the Philippines)

NCM 1202 (Health Assessment)

Physical Assessment Performance Checklist

Name:__________________________________________ Score/Rating: _____________________________

Year/Section: ____________________________________ Date: ____________________________________

Scale: 2 – Correctly done (Good) 1 – Incorrectly done (Needs practice) 0 – Not done

Procedure Scale Remarks

Preparation
1. Assemble/gather equipment to the body system/region to be assessed 2 1 0
2. Greet /identify client 2 1 0
3. Explain the procedure to be done, the reason and how the client can 2 1 0
cooperate
4. Perform hand hygiene and observe other appropriate infection control 2 1 0
precautions
5. Provide privacy
ASSESSMENT: GENERAL SURVEY
6. General appearance, facial expression, body built, height and weight in 2 1 0
relation to age/developmental stage
7. Client’s posture/gait, hygiene/grooming, body/breath odor, signs of distress 2 1 0
8. Apply gloves as necessary 2 1 0
ASSESSMENT: HEAD
9. Inspect and palpate the head for size, shape and configuration 2 1 0
10. Note consistency, distribution and color of hair 2 1 0
11. Observe face for symmetry, facial features, expressions and skin condition 2 1 0
12. Palpate the temporal arteries for elasticity and tenderness 2 1 0
13. As client opens and closes mouth, palpate the temporo-mandibular joint 2 1 0
(TMJ) for tenderness, swelling and crepitation
ASSESSMENT: EYES
14. Test visual acuity. Ask client to read smallest possible line of letters, first 2 1 0
with both eyes open and then one eye at a time
15. Inspect external eye structure (eyelids, eyelashes, eyeballs, and eyebrows), 2 1 0
cornea, conjunctiva and sclera. Note color, edema, symmetry and alignment
16. Examine the pupils for equality of size, shape, reaction to light by darkening 2 1 0
the room and using a penlight to shine the lights on each pupil.
ASSESSMENT: EARS
17. Inspect the external ear bilaterally for shape, size and lesions, discoloration 2 1 0
and discharge
18. Palpate the ear and mastoid process for tenderness 2 1 0
ASSESSMENT: NOSE AND SINUSES
19. Inspect the external nose for color, shape and consistency. Palpate external 2 1 0
nose for tenderness
20. Check patency of airflow through nostrils (occlude one nostril externally
with a finger while the client breathes through the other; repeat for the 2 1 0
other side
ASSESSMENT: MOUTH AND THROAT
21. Perform hand hygiene and don gloves 2 1 0
22. Inspect the lips for consistency, color and lesions 2 1 0
 Procedure Scale Remarks
23. Inspect the teeth for number and condition 2 1 0
24. Check the gums and buccal mucosa for color, consistency, lesions 2 1 0
25. Inspect the hard and soft palate for color and integrity by asking the client 2 1 0
to open mouth wide using a tongue blade and penlight
26. Ask client to say “Aaah” and observe the rise of the uvula 2 1 0
27. Inspect tonsils for color, size and exudates 2 1 0
28. Inspect the tongue for color, moisture, size and texture, Inspect frenulum 2 1 0
and Wharton’s duct
29. Palpate the tongue for masses and tenderness 2 1 0
ASSESSMENT: NECK
30. Inspect the neck for lesions, masses, swelling 2 1 0
31. Test range of motion 2 1 0
32. Palpate lymph nodes in slow and circular motion 2 1 0
33. Palpate the trachea for alignment and deviation. Inspect the thyroid gland 2 1 0
for visible enlargement and masses
34. Inspect and palpate carotid arteries. Auscultate bruit 2 1 0
ASSESSMENT: ARMS, HANDS AND FINGERS
35. Inspect the upper extremities for over-all skin coloration, texture, moisture, 2 1 0
masses and lesions
36. Palpate shoulders and arms for tenderness, swelling and temperature 2 1 0
37. Assess epitrochlear lymph nodes 2 1 0
38. Test ROM of shoulders and elbows 2 1 0
39. Palpate the brachial, ulnar and radial pulses 2 1 0
40. Inspect palms of hands and palpate for temperature 2 1 0
41. Check for capillary refill 2 1 0
42. Test ROM of wrist 2 1 0
43. Test rapid alternating movements of hands 2 1 0
ASSESSMENT: POSTERIOR AND LATERAL CHEST
44. Inspect configuration and shape of scapulae and chest wall 2 1 0
45. Note posture and use of accessory muscles during breathing 2 1 0
46. Palpate for tenderness, sensation, crepitus, masses and fremitus 2 1 0
47. Evaluate chest expansion at level T9 and T10 2 1 0
48. Percuss the posterior chest 2 1 0
49. Auscultate for breath sounds and voice sounds 2 1 0
ASSESSMENT: ANTERIOR CHEST
50. Expose anterior chest 2 1 0
51. Inspect anteroposterior diameter of the chest, slope of ribs and color 2 1 0
52. Note quality and pattern of respiration 2 1 0
53. Observe intercostal spaces for bulging or retractions and use of accessory 2 1 0
muscles
54. Palpate for tenderness, sensations, masses, lesions, fremitus and anterior 2 1 0
chest expansion
55. Percuss for tone above clavicles and then at the intercostals spaces 2 1 0
(compare bilaterally)
56. Auscultate for anterior breath and voice sounds 2 1 0
57. Pinch skin over the sternum/clavicle to assess mobility and turgor 2 1 0
ASSESSMENT: HEART
58. Inspect and palpate for apical impulse 2 1 0
59. Palpate the apex, left sternal border and base of the heart for any abnormal 2 1 0
pulsations
60. Auscultate heart sounds, rate and rhythm 2 1 0
61. Ask client to lie on left side, use bell of stethoscope to listen for the apex of 2 1 0
the heart
62. Ask the client to lean forward and exhale; use bell of stethoscope to listen 2 1 0
over apex and left sternal border of the heart
Cover chest with gown and drape to expose abdomen
 Procedure Scale Remarks
ASSESSMENT: ABDOMEN
63. Inspect the overall skin color, vascularity, striae, lesions and rashes; 2 1 0
location, contour and color of the umbilicus; symmetry and contour of the
abdomen; aortic pulsations or peristaltic waves
64. Auscultate for bowel sounds; vascular sounds and friction rubs 2 1 0
65. Percuss over four abdominal quadrants, liver and spleen location and size 2 1 0
66. Lightly palpate over four abdominal quadrants to identify tenderness and 2 1 0
muscular resistance
67. Deeply palpate over four abdominal quadrants for masses; liver, spleen and 2 1 0
kidneys for enlargement and irregularities
68. Feel for aortic pulse 2 1 0
Replace gown and drape so lower extremities are exposed
ASSESSMENT: LEGS, FEET AND TOES
69. Inspect the lower extremities for over-all skin coloration, texture, moisture, 2 1 0
masses, lesions and varicosities. Note hair distribution
70. Observe muscles of the legs and feet 2 1 0
71. Palpate for pulses (femoral, popliteal, posterior tibial and dorsalis pedis) 2 1 0
72. Palpate for edema, skin temperature, muscle size and tone of legs and feet 2 1 0
73. Palpate joint of hips, knees and ankles 2 1 0
74. Test ROM of hips, knees and ankles 2 1 0
75. Assess for capillary refill 2 1 0

TOTAL:

_____________________________ _______________________________
Signature over printed name Signature over printed name of CI