GENERAL RULES

Done
General Rules Done Not Done
properly
At the beginning of every procedure
1. Introduce self to the patient
2. Get and verify the patient's pertinent information (Name,
Age, Sex)
3. Explain to the patient the procedure or examination to be
done
4. Get consent of the patient
5. Hand washing
At the end of the procedure
6. Ensure the patient's comfort
7. Say thank you
8. Hand washing
9. Recording

GENERAL SURVEY

Done
General Survey Done Not Done
properly
Make an accurate general survey and report
A. General appearance
B. Level of comfort
C. Level of consciousness
D. Skin color
E. Ambulatory status
F. Posture and general motor activity
G. Body habitus
H. Body symmetry
I. Personal hygiene and grooming
J. Facies
K. Mood and affect
- Attitude towards the examiner
- Predominant mood
- Affect
- Appropriateness
L. Psychomotor activity and speech
- Manner of speech
- Abnormal movements
M. Thought process and content
N. Cognitive functions
- Orientation
- Memory
 ANTHROPOMETRIC ASSESSMENT

Done
Height Determination Done Not Done
properly
Standing
1. Remove shoes
2. Stand straight and place back against the measuring tape on
the wall where the measuring tape is affixed; or stand erect,
feet together, and with head, shoulders, buttocks, and heels
touching the measuring tape.
3. Measure from the top of the head to the heels.
4. Read in centimeters.
5. Convert to meters and record.
Supine
1. Body fully extended.
2. Measure from the tip of the head to the heels with a tape
measure.
3. Read in centimeters.
4. Convert to meters and record.

Done
Weight Determination Done Not Done
properly
1. Patient to empty his bladder
2. Remove shoes.
3. Use a calibrated weighing scale. Make sure that the needle is
at zero.
4. Measure at approximately the same time of the day and
wearing the same amount of clothing a previous
measurement.
5. Record in kilograms.

Done
Estimating Frame Size Done Not Done
properly
Wrist
1. Patient to stand with the left arm hanging by his side while the
right arm is slightly flexed at the shoulder; the elbow is
extended, the forearm supinated, and the hand relaxed.
2. Measure the wrist distal to the styloid process using a flexible
tape.
3. Ratio height to circumference.

Done
Mid-arm Circumference (MAC) Determination Done Not Done
properly
1. Examiner to stand in front of seated patient.
2. Midpoint of the patient's non-dominant arm identified.
3. Olecranon process of the elbow identified.
4. Tape measure placed between the acromial process and the
olecranon process.
5. Let patient's arm hang loosely at the side as you place the
tape measure around his arm at the previously marked
midpoint.
6. Measurement in centimeters.
7. Interpretation of MAC based on the table.
 Done
Triceps Skin Fold (TSF) Determination Done Not Done
properly
1. Midpoint of the non-dominant arm located.
2. Let the non-dominant arm hang loosely at the side as you grasp
a fold of skin at the midpoint on the posterior aspect of the
arm.
3. Apply the caliper and read. Perform 3 times.
4. Flex the arm muscle to ensure that only the skin is grasped.
5. Calculate the average of the 3 recordings and record the
measurement in centimeters.
6. Interpret the TSF based on the table.

Done
Calculate for the Mid-arm Muscle Circumference (MAMC) Done Not Done
properly
1. Calculate the Mid-arm Muscle Circumference (MAMC) using the
following formula: MAMC = MAC (cm) - (0.314 x TSF (mm))
2. Interpret based on the table.

Waist Circumference (WC), Hip Circumference (HC), and Waist-to-Hip Done

Done Not Done
Ratio (WHR) properly
1. Measure between the last rib and the iliac crest, at minimal
inspiration.
2. Measure at the widest part of the buttocks.
3. Divide the waist circumference by the hip circumference.
4. Interpret based on the table.

Done
Areas assessed for loss of subcutaneous fat and muscle wasting Done Not Done
properly
Loss of subcutaneous fat
1. Triceps regions of the arms
2. Midaxillary line at the costal margin
3. The interosseous and palmar areas of the hand
4. Deltoids of the shoulder
Muscle wasting
5. Quadriceps femoris
6. Deltoid

TEMPERATURE TAKING

Axillary Temperature Determination using a Digital Done

Done Not Done
Thermometer properly
1. Check for axillary abscess, shoulder limitation/fracture,
open sores or abrasions
2. Access axillary region
3. Pat axilla dry.
4. Clean tip with a disinfectant before turning it on.
5. Place the thermometer at the center of the armpit,
pointing the stem to the upper chest and making sure
the thermometer is touching only the skin and not the
clothing
6. Firmly appose the arm to the chest and wait until the
beep is heard.
7. Remove the probe and read temperature in the LED
window.
8. Record the temperature reading.
9. Help the patient wear back his gown/clothes.
 10. Clean the digital thermometer with disinfectant.

Done
Oral Temperature Determination using a Digital Thermometer Done Not Done
Properly
1. The patient should not be unconscious, restless or
unable to close or open mouth (e.g., tongue cancer or
lock jaw). There should be no food or food particles
inside the mouth.
2. Wash hands or use disinfectant, then air dry.
3. Explain the procedure to the patient and get consent.
4. Clean the thermometer and air dry.
5. Place the thermometer in the sublingual pocket and
have the patient close his mouth around it.
6. Instruct patient not to bite down.
7. Leave the thermometer in place until the beep is heard.
8. Ask the patient to open his mouth and remove the
thermometer.
9. Read the temperature in the LED window and record.
10. Clean the digital thermometer with disinfectant.

Tympanic membrane temperature determination using a Done

Done Not Done
Digital Thermometer Properly
1. There should be no impacted cerumen, otitis media
(interna or externa).
2. Wash hands or use disinfectant, then air dry.
3. Explain the procedure to the patient and get consent.
4. Clean the thermometer and place a new and
undamaged probe cover.
5. Turn on the thermometer.
6. Straighten the external auditory canal and gently insert
the probe into the external auditory canal.
7. Wait for the beep and once heard, gently remove the
probe.
8. Read the temperature in the LED window and record.
9. Remove the probe cover and dispose in a biohazard
waste container.
10. Clean the digital thermometer with disinfectant.

PULSE RATE DETERMINATION

Done
Apical Impulse Determination Done Not Done
Properly
1. Position patient.
2. Expose chest area without compromising the patient’s
privacy
3. Palpate for the apical impulse using the tip of the right
middle and index fingers
4. If not visible, palpate for the apical impulse in the 5th or
the 6th intercostal space anterior axillary, mid or
posterior line until detected.
5. Place the proximal parts of 4 fingers in the 5th
intercostal space midclavicular line
6. If not able to palpate the apex beat, move fingers
laterally or medially until the apex beat is located.
7. If unsuccessful, warm stethoscope. Place the
stethoscope (bell or diaphragm) in the 5th intercostal
space midclavicular line or adjust accordingly
8. Listen carefully to the heartbeat.
9. Place patient to left lateral decubitus position to
accentuate the apical impulse
10. Count the apical impulse for one full minute using
watch with second hand
11. Note any irregularities in rhythm and volume
12. Record findings.

Done
Temporal Pulse Done Not Done
Properly
1. Face the sitting or recumbent patient.
2. Use index and middle fingers to feel the zygomatic arch
3. Move fingers to feel the pulsation of the temporal pulse.
4. Locate the temporal pulse on the left side using the
same technique.
5. Simultaneously palpate both.
6. Note the volume of pulsation on each artery and
compare.
7. Note any thrill or bruit.
8. Record

Done
Radial Pulse Done Not Done
Properly
1. Position the patient’s arm in a relaxed position.
2. Locate right radial artery.
3. Count the pulse rate for one full minute.
4. Locate the radial pulse on the left side.
5. Count the pulse rate for one full minute.
6. Simultaneously palpate the radial pulses on both sides
to compare.
7. Evaluate and state the pulse rhythm.
8. Compare the volume of pulsation on each artery.
9. Record.

Done
Brachial Pulse Done Not Done
Properly
1. Face the sitting or recumbent patient.
2. Support the patient’s forearm with left hand.
3. Palpate for the patient’s brachial artery with your right
hand.
4. Locate the brachial pulse on the left side using the
same technique.
5. Simultaneously palpate the brachial pulses on both
sides to compare.
6. Compare volume of pulsation on each artery.
7. Note any thrill.
8. Record.
 Done
Carotid Pulse Done Not Done
Properly
1. Patient sitting, or if supine, trunk elevated to about 30 –
45 degrees
2. Elevate patient’s chin and turn face to the left side
3. Inspect for visible carotid pulsations.
4. With index and middle fingers, locate the right carotid
artery.
5. With the other hand, bend the patient’s head slightly to
the side being examined.
6. Apply varied degrees of pressure in palpating the pulse
until the maximum pulsation is appreciated.
7. Locate the carotid pulse on the left side using the same
technique.
8. Never press on both carotid arteries at the same time.
Compare:
Amplitude, contour, rate or speed of rise, rate or speed of
pulse fall, thrill, bruit
9. Draw the carotid artery pulse.
10. Record findings.

Carotid Right Left

Amplitude
Contour
Rate or speed of rise
Rate or speed of fall
Thrills
Bruit

Done
Popliteal Pulse Done Not Done
Properly
1. Place patient in supine position.
2. Place the fingers of your both hands in the popliteal
space of the right leg, with the palms in complete contact
with the patient’s skin including the anterolateral aspect
of the knee.
3. Relax the muscles around the popliteal area.
4. With firm pressure, squeeze with the entire hand,
providing an equal sensation all through the hand.
5. Slightly dorsiflex patient’s foot.
6. Press deeply into the popliteal fossa.
7. Locate the popliteal pulse on the left side.
8. Compare both sides.
9. Record.

Done Not
Posterior Tibial Pulse Done
Properly Done
1. Place patient in the supine position.
2. Stand at the foot or the side of the examining table.
3. Locate the right posterior tibial artery.
4. Provide stability.
5. Locate the posterior tibial pulse on the left side.
6. Simultaneously palpate the posterior tibial pulse on both
sides to compare.
7. Compare the volume of pulsation on each artery.
8. Record.

Done
Dorsalis Pedis Pulse Done Not Done
Properly
1.. Place patient in supine position.
2. Stand at the foot or the side of the examining table.
3. Locate the right dorsalis pedis artery.
4. Dorsiflex the foot to various degrees.
5. Locate the dorsalis pedis pulse on the left side.
6. Simultaneously palpate the dorsalis pedis pulses on both
sides to compare.
7. Compare the volume of pulsation on each artery.
8. Record.

Done
Femoral Pulse Done Not Done
Properly
1. Stand on the right side of the patient who is reclining on
the bed at a 45-degree angle.
2. Ask permission to expose groin area.
3. Expose groin area.
4. Locate the right femoral artery.
5. Locate the femoral pulse on the left side.
6. Simultaneously palpate the femoral pulses on both sides
to compare.
7. Compare the volume of pulsation on each artery.
8. Note any thrill.
9. Record.

Done
Simultaneous Radial and Femoral Pulses Evaluation Done Not Done
Properly
1. Simultaneously palpate the radial and femoral pulses on
one side to compare.
2. Simultaneously palpate the radial and femoral pulses on
the other side to compare.
3. Record findings.

Radial/Femoral Right Left

Pulse delay
Volume reduction

Simultaneous Brachial and Radial Pulse Determination

Done
(Estimation of Systolic Blood Pressure without using Blood Done Not Done
Properly
Pressure Cuff)
1. Simultaneously palpate the brachial and the radial pulses
on same side.
2. Estimate systolic blood pressure on examined arm
3. State estimated systolic blood pressure on the side
examined.
4. Note the elasticity/compressibility of the pulse on the
said side.
5. Perform the same procedure on the other side.
6. State estimated systolic blood pressure on the same side
examined.
7. Note the elasticity/compressibility of the pulse.
8. Compare estimated systolic blood pressure in both
sides.
9. Record findings.

Degree of Brachial Pressure to Right Left

obliterate the radial pulse
Slight (<120 mm Hg)
Moderate (120 – 160 mm Hg)
Marked (>160 mm Hg)

RESPIRATION RATE

Respiration rate, depth, rhythm and pattern determination Done Done Not Done
properly
1. Patient in sitting position with arm in the same position
as when counting the radial pulse.
2. Count rise and fall (cycles) and observe the patient's
breathing pattern and depth or
In supine patient, cross patient's arm across his chest.
3. Count the number of rise and fall (cycles) for full minute.
4. Note rate, depth, and pattern.
5. Record.

Done
Accentuating Inaudible Korotkoff Sounds Done Not Done
properly
1. Patient to open and close his fist ten times (in case of
the lower extremities, flex and extend the ankle
repeatedly).
2. Elevate patient's arm
3.. Inflate the cuff quickly.

BLOOD PRESSURE

Done Not
Blood Pressure Determination Done
properly Done
1. Ask for intake/engagement of the following 30 - 60
minutes prior to the blood pressure determination:
caffeinated drinks, smoked cigarette/cigar, alcohol, food,
water, illicit drugs, antihypertensive meds, NSAIDs,
steroids
2. Ask for activities done 30 - 60 minutes prior to blood
pressure determination, exercise or its equivalent.
3. Ask for any condition the patient might be having prior to
or during blood pressure determination: anxiety, pain,
bladder distention, temperature change, noise
4. Patient to rest for 5 minutes in a quiet and comfortably
warm room.
5. Patient to refrain from talking or doing anything while
pressure is taken.
6. Avoid talking during the procedure.
 Done
Upper Extremity Done Not Done
properly
7. Stay on the side where the blood pressure it taken.
8. Patient: comfortable, sit with legs uncrossed, feet flat on
the floor, back supported against the chair, bared arm
resting on a standard table or other support, maintain the
midpoint of the upper arm always at the level of the heart.

If supine, patient should: be positioned at 30 to 45 degree

angle, maintain the midpoint of the upper arm always at
the level of the heart, draped properly
If standing, patient should: put arm at the mid chest level,
maintain the midpoint of the upper arm always at the
level of the heart
9. Remove clothing around patient's arm and avoid rolling
up the sleeve.
10. Estimate by inspection, or measure with a tape, the
circumference of the bare upper arm at midpoint.
11. Select and use an appropriately sized cuff.
12. Record if in doubt what size to use, then use a larger
size cuff instead. Record if the available cuff is too small.
13. Use index and middle finger to palpate for the patient's
brachial and radial arteries.
14. Apply the appropriately sized cuff 2.5 cm above the
antecubital fossa where the chest piece of the
stethoscope is to be placed.
15. Ensure that the center of the inflatable bladder of the
BP cuff is over the brachial artery pulsation.
16. Wrap and secure the cuff snuggly around the patient's
bare arm.
17. Place the manometer at eye level, hook the manometer
in the cloth cover of the inflatable bladder.
18. Ensure that tubing from cuff is unobstructed.
19. Measure palpatory BP.
20. Use index and middle finger to palpate the radial artery.
21. With the other hand, rapidly inflate cuff 10 mmHg
increments while palpating the radial pulse, and note
when the pulse disappears.
22. Countercheck by further increasing by 20 - 30 mmHg
above the level the pulse disappears during cuff inflation,
after which deflate cuff by 2 - 3 mmHg/sec and note at
which level the radial pulse reappears during deflation.

23. Read BP on the manometer and state palpatory

(systolic) BP
24. Deflate the cuff.
25. Measure auscultatory BP.
26. Wait 15 - 30 seconds after getting the palpatory BP.
27. Place the earpieces of the stethoscope into the ear
canals, angled forwardly to fit snugly.
28. Palpate for the brachial artery pulsation using index and
middle finger.
29. Place the chest piece of the stethoscope over the
brachial artery pulsation.
30. Inflate the BP cuff rapidly and steadily to a pressure 20
- 30 mmHg above the palpatory (systolic) BP previously
recorded.
31. Partially unscrew (open) the valve and slowly deflate
BP cuff by 2 - 3 mmHg/sec while listening for the
appearance of the Korotkoff sounds.
32. Note the level of pressure on the manometer when the
first Korotkoff sound is heard (Phase I). Record as the
auscultatory systolic BP rounded off (upward) to the
nearest 0 - 5 mmHg.
33. Continue to deflate slowly by 2 - 3 mmHg/sec and note
the level on the manometer when the Korotkoff sound
becomes muffled (Phase IV). Record this phase rounded
off (upward) to the nearest 0 - 5 mmHg.
34. Continue to deflate slowly by 2 - 3 mmHg /sec and note
the level on the manometer when the Korotkoff sound
disappears. State this as the diastolic BP (Phase V)
rounded off (upward) to the nearest 0 - 5 mmHg.
35. After the Korotkoff sound is heard, deflate the cuff
slowly for at least another 10 mmHg to ensure that no
further sounds are audible.
36. Allow the patient to rest at least 30 seconds.
37. Record the Korotkoff Phases I/IV-V (e.g., 140/70 - 30)
38. Repeat the measurement after at least 3o seconds, and
average the two readings.
39. Record all values together with the name of the patient,
the date and time of the measurement, the arm on which
the measurement was made, the patient's position, and
the cuff size (when a nonstandard size is used).

Done
Lower Extremity Done Not Done
properly
Follow same procedure as BP taken in the upper extremities
with the following differences.
7. Stay on the side where the blood pressure it taken.
8. Patient in prone or supine position with leg slightly flexed.
9. Use a long and wide thigh cuff with a bladder size of 18 x
42 cm
10. Apply the cuff to the mid-thigh.
11. Place the bladder at the center over the posterior
surface.
12. Wrap the cuff securely and snugly
13. Listen over the popliteal artery.
14. State the BP on the right lower extremity
15. Perform the above procedures to the other lower
extremity. State the BP on the left lower extremity.
16. Compare the BP on the left and the right lower
extremities and state if the difference is within acceptable
limits.
17. Compare the BP on the upper and the lower extremities
and state if the difference is within acceptable limits.

Done
Osler sign of Pseudohypertension (Osler's Maneuver) Done Not Done
properly
1. Position and prepare the patient.
2. Simultaneously palpate the brachial and the radial pulses
with elbow flexion on same side.
3. Using middle and index fingers of one hand, approach the
radial pulse laterally above the wrist. Using middle and
index fingers of the other hand, approach the brachial
artery medial to the biceps tendon.
4. Apply marked pressure on the brachial artery or
Apply pressure by cuff inflation on the brachial artery.
5. Same steps on the other upper extremity for comparison.
 AV fistula detection in patient with wide pulse pressure
Done
(Branham's or Nicoladoni-Nicoladoni-Branham's or Nicoladoni's Done Not Done
properly
sign)
1. Position and prepare patient as in the determination of the
blood pressure in the suspected limb.
2. Examiner 1 obtains and records the baseline heart rate in
one full minute via the radial pulse in the other arm with
normal pulse pressure.
3. Examiner 2 inflates the blood pressure cuff on the
suspected limb until the radial pulse disappears.
4. Examiner 1 obtains and records in one full minute another
heart rate reading during the time the blood pressure cuff
is inflated in the suspected limb.
5. Examiner 2 slowly deflates the blood pressure cuff as
Examiner 1 again takes the heart rate.
5. Interpret findings.

Done
Orthostatic or postural hypotension test Done Not Done
properly
1. Examiner 1 orients the patient of the sequence of the
procedure to be done.
2. Examiner 1 places the blood pressure cuff on one arm.
3. Examiner 1 instructs the patient to assume a supine
position.
4. Immediately after two minutes of supine position,
Examiner 1 takes a blood pressure reading.
5. Examiner 2 simultaneously takes the pulse rate in full
minute via the radial pulse on the other arm while the
patient is in supine position.
6. Patient is asked to stand up for at least 3 minutes after
which Examiner 1 takes another blood pressure reading.
7. Examiner 2 simultaneously takes the pulse rate again for
a full minute via the radial pulse on the other arm while the
patient is standing.
8. Record finding in both supine and standing positions.
9. Interpret findings.

*Adapted from Marcial’s Comprehensive Guide to Physical Examination Checklist.