PEROS (Physical Assessment and Review of Systems)

Note: Assessment should follow IPPA / IAPP fashion if applicable. This serves as
guide in performing assessment thoroughly

In writing your PEROS requirement, please draw your own table following this format
in a clean sheet of long bond paper so that you can utilize more space for your assessment
findings.

Areas Assessed Subjective Objective Findings Problem

Findings Identified
General Health -Have you been Inspection
Survey feeling well? Inspect overall appearance The following may
-Have you lost or noting appropriate growth and be applicable:
gained weight development according to age -Anxiety (specify
recently? (for children). level)
-Check patient’s -Describe the posture, body -Body Image
orientation and size and type, height, weight Disturbance
intactness of and grooming (dress and -Altered Comfort
memory. hygiene). -Impaired Verbal
-How does the pt. smell? Communication
-Watch signs of distress and -Acute Confusion
check facial characteristics. -Risk for Acute
-Inspect level of alertness Confusion
(alert, lethargic or stupurous), -Ineffective
memory, coherence and Individual Coping
speech. -Ineffective Denial
-Assess the client’s attitude, -Risk for
affect and mood. Developmental
-Note for any deformities, Delay
check coordination of -Delayed Growth
movements when sitting, and Development
standing and walking. -Impaired Memory
-Describe gait (does the patient -Risk for Injury
need assistance in walking? If -Powerlessness
so – describe. -Social Isolation
-Describe the strides upon -Fear
walking, is the gait steady?)If -Imbalanced
client is bedridden, describe Nutrition: Less
the level and kind of assistance than Body
the client need. Requirements
-Imbalanced
Nutrition: More
than Body
Requirements
-Disturbed
 Thought Process
-Self Care Deficit
Integu-mentary -Do you have skin Inspection -Altered Body
System rashes or lesions? -Inspect skin color and Temperature:
-Do you have uniformity. Hyper-thermia
excessive itching? -Inspect skin for intactness. -Injury
-Do you sweat a Note location of any break in -Impaired Skin
lot? Any odor skin integrity and describe its Integrity
problems? appearance. -Risk for Impaired
-Are you exposed to -Note distribution of hair all Skin Integrity
the sun? over the body and note -Ineffective
-Do you use location of unevenness of hair Thermoregulation
sunblock? distribution. -Self Care Deficit
-Note hair distribution on the -Impaired Tissue
head, texture, color and length Integrity
of hair. -Body Image
-Note presence of lice, nits, Disturbance
dandruff, and condition of the -Pain, Acute or
scalp. Chronic
-Describe nail condition on -Allergy Response,
both upper and lower Latex
extremities giving emphasis on -Hypothermia
its shape, curvature and angle, -Infection
color and texture. Also inspect -Risk for Infection
the tissues surrounding the
nail.
Palpation
-Palpate skin and note its
turgor, mobility and moisture.
-If there’s presence of edema,
apply pressure on skin surface
and note for pitting.
-------------------- Head and face – Head and face – (Inspection) -Body Image
-------------------- (Palpation) note symmetry, size, Disturbance
-------------------- -Palpate the head proportion and contours of the -Pain, Acute or
-------------------- and face for any head. Chronic
-------------------- tenderness or pain. -Note symmetry of facial -Impaired Verbal
-------------------- If there is, ask movements Communication
-------------------- COLDSPA. (Palpation) -Impaired
--------------- -Palpate for presence of any Dentition
HEENT (Percussion) masses. -Impaired
a. Head and face -Percuss sinuses for Eyes – (inspection) Inspect Swallowing
b. Eyes any tenderness eyebrows and eye lashes for -Altered Sensory
c. Ears (COLDSPA). shape, size and eveness of hair Perception
d. Nose Eyes – Do you have distribution. (Eye lashes may -Impaired Oral
e. Oral Cavity any visual problem? be pointing internally – a Mucous Membrane
-Do you wear phenomenon called trachiasis). -Ineffective
glasses? If yes, do -Inspect pupils and note if Airway Clearance
you wear them PERRLA (pupils that does not
consistently, assume a circular shape is
specially while at called collaboma), determine
school/work? color of sclera, describe
-Do you wear corneal size, light reflex and
contact lenses? color (corneal scars may
-When was your appear white over the cornea
last eye and may impede vision).
examination? What -Inspect for presence of
was the result? redness, swelling and
-Do you use any discharges.
eye medications? If -Note presence of periorbital
yes, identify. edema.
-Test muscle strength of the
Inspection eyes (note presence of
-Check the vision nystagmus and strabismus)
using snellen’s using cardinal fields of gaze
chart or rosenbaum test, cover and uncover test
card. and corneal light reflex test.
-Describe -Check corneal sensitivity
peripheral vision using a wisp of cotton.
and any limitations. Ears –(Inspection) Note
Palpation symmetry, size and position of
-Palpate the ears, assess for presence of
periorbital area for discharges and note odor and
presence of color.
tenderness (Palpation)
(COLDSPA). -Palpate auricles for texture,
Ears – Do you have elasticity and areas of
any hearing tenderness.
problem? Nose – (Inspection) describe
-Do you listen to symmetry, size and
loud music? distribution of hair within the
-When was your nostrils.
last hearing exam? -Note presence of discharges,
-Check hearing if there is, describe color,
acuity using consistency, quantity and odor.
whisper test, watch -Note patency of nares, color
tick test, Weber test of nasal mucosa and check for
and Rinne test. flaring.
Nose. -Lightly palpate the external
–Do you use any nose for presence of masses
inhalers or and displacement of bone and
nebulization? How cartilage.
 often? Oral cavity–
-Check ability to (inspection).Describe contour,
distinguish different symmetry, moisture, color and
scents. intactness of lips.
(Palpation) -Describe texture, color and
-Palpate externally intactness of gums, oral
for any tenderness mucosa as well as the tonsils
(COLDSPA). and uvula.
Oral cavity – How -Describe color, presence of
many second teeth carries, decays and number of
do you have? When teeth.
was your last visit -Inspect tongue color,
to the dentist? symmetry, size, shape and
- Do you see an position.
orthodontist? -Assess swallowing ability and
-Note presence of ability to determine taste
tooth and gum pain. (anterior and posterior).
-Assess presence of (Palpation)
pain on tonsils and
uvula.
Neck -Note for presence -Palpate tongue and check for -Impaired Mobility
of pain, always take strength, nodules and lumps. -Body Image
the COLDSPA. Inspection Disturbance
-Do you experience -Note symmetry of appearance -Risk for
stiff neck? How including size, contours, and Ineffective Airway
often? presence of distended veins. Clearance
Palpation - Note the location and -Infection
-Palpate for any symmetry of the trachea. -Risk for Infection
tenderness -Inspect the neck muscles
(COLDSPA). (sternocleidomastoid and
trapezius muscle).
-Observe head movement in all
directions.
Palpation
-Palpate for enlargement of
cervical nodes and
enlargement of thyroid gland
of the neck.
-Palpate the trachea for any
deviation.
-Palpate neck muscle for tone,
strength, deviation and
presence of lumps or masses.
-Check shoulder strength by
instructing the client to shrug
shoulders with or without
 resistance.
Auscultation
-Auscultate carotid artery for
bruit sounds.
Respira-tory -Do you have Inspection -Ineffective
System asthma? -Inspect shape and symmetry Airway Clearance
-Do you ever have of the thorax from posterior -Risk for
trouble breathing or and lateral views, Inspect the Ineffective Airway
do you wheeze spinal alignment for Clearance
when exercising / deformities. -Risk for
running? -Note symmetry of chest Aspiration
-Are you exposed to expansion, any abnormal -Impaired Gas
air pollutants, retractions of the ribcage, Exchange
smoke, or second- supraclavicular retractions, -Impaired
hand smoke? rate, depth and rhythm of Spontaneous
-Do you feel any respirations. Ventilation
discomforts or pain Palpation -Dysfunctional
when breathing? -Palpate for vocal (tactile) Ventilator
Palpation fremitus on the entire chest Weaning Response
-Palpate for any while the patient says “99” -Infection
tenderness on both noting its symmetry of -Pain
anterior and vibrations with the other lung
posterior chest wall. and area of diminishing
vibrations.
Percussion
-Percuss each intercostal
spaces for resonance – normal
sound (never percuss over a
bone as this will create flat
sounds).
-Note the hyper-resonance of
the left lower anterior chest
due to air filled stomach.
Normally, the rest of the lung
fields are resonant.
-Abnormal (dullness –
decreased air in lungs such as
atelectasis, pulmonary edema
and hemothorax;
hyperresonance –
pneumothorax, acute asthma.
-Percuss for diaphragmatic
excursion – point where
resonance changes to dullness.
(Normal diaphragmatic
excursion is 5-6 cm.).
 Auscultation
-Auscultate for breathing /
lung sounds and describe (note
any adventitious lung sounds).
-Normal sounds: bronchial
sound – main bronchus,
bronchovesicular sounds –
lower part of the bronchial
tree, vesicular sounds – lung
field.
Cardio- -Do you have any Inspection -Decreased
vascular chest pain? If yes, -Inspect for presence of edema Cardiac Output
System identify on other body parts -Ineffective Tissue
COLDSPA. -Inspect jugular vein for Perfusion
-Does your heart distention and identify the -Fluid Volume
ever skip highest point a.k.a point of Excess
maximal impulse- PMI (at -Fluid Volume
which pulsations can be seen Deficit
or palpated).
Palpation
a beat? -Check capillary refill time and
record, palpate peripheral -Pain
pulses and compare them in all -Altered Comfort
four -Anxiety
-Fear
-Knowledge
Deficit

extremities and count in one

full minute. Describe strength
of each pulse whether thready
or strong bounding.
-Palpate carotid artery with
extreme caution.
-Palpate pulsations on the
anterior chest wall
(sternoclavicular area, aortic
area, pulmonic area and left
clavicular area) and note any
lifts, heaves or vibrations.
Auscultation
-Auscultate heart rate, rhythm,
or presence of adventitious and
extra heart sounds, bruits of
thrills using both bell and
diaphragm of the stethoscope
 in the following areas:
(APe To Man and Erbs point –
nemonics)
Aortic – 2nd intercostal space
near right sternum
Pulmonic – 2nd intercostal
space near left sternum
Tricuspid – 5th intercostal
space near left sternum
Mitral – 5th intercostal space
mid clavicular line left thorax
Erbs point – 3rd intercostals
space near left sternum
Breast and -Do you perform Inspection -Ineffective
axilla breast self- -Inspect the breast for size, Breastfeeding
examination? How symmetry, contour (dimpling), -Interrupted Breast
often? shape, color, presence of Feeding
-Have you lesions and discharges -Pain
undergone (including areola and nipples). -Impaired Skin
mammography Palpation Integrity
procedures? -Using spiral/circular, wedge, -Body Image
-Have you had any vertical/ lateral, horizontal / Disturbed
breast surgery? transverse technique, palpate
-Do you experience the whole breast area including
breast tenderness? tail of Spence.
How often? -Palpate the axillary, sub
COLDSPA. clavicular, and supraclavicular
Palpation lymph nodes while the client
-Note presence of sits.
pain / tenderness
upon breast
palpation.
Gastro- -Do you have any Note: Order of abdominal -Bowel
intestinal stomach problems? assessment should always be Incontinence
System and the Vomiting? inspection, auscultation, -Constipation
abdomen -How often do you percussion and palpation. -Perceived
have a bowel Warning: it may cause death Constipation
movement? for the ff reasons: -Risk for
-Do you feel any Adults – Abdominal Aortic constipation
pulsations in your Aneurysm -Diarrhea
abdomen? Children – Wilms Tumor -Risk for Diarrhea
Inspection Inspection: -Ineffective Infant
-Check sensitivity -Assess ability to swallow. Feeding Pattern
of the abdomen -Inspect contour, size and -Risk for Impaired
using open safety shape of abdominal area. Liver Function
pin – noting its -Inspect umbilicus noting -Nausea
 sensitivity to dull or position, contour, color and
sharp object. discharge.
Palpation -Ask client to raise head off
-Palpate for any bed and any bulges or hernias.
pain starting with -Observe abdominal
light palpation to movements and pulsations.
deep palpation. -Stroke the abdomen upward
using a tongue blade and
toward the umbilicus in each
quadrant and note reflexes.
Auscultation
-Auscultate bowel sounds in
all four quadrants of the
abdomen and note each of
them.

-Auscultate for presence of

pulsations on the abdomen.
Percussion
-Percuss for presence of
distention caused by gas, size
of liver and spleen.
Palpation
-Palpate for presence of
masses (from light to deep
palpation).
Genito- -Do you have Inspection -Fluid Volume
urinary / bladder control? (Female and Male) Deficit
Repro-ductive -Do you wet the -Inspect genitalia and note its -Risk for Fluid
system bed? color, intactness, lesions and Volume Deficit
Palpation discharges. -Fluid Volume
-Palpate genitalia -Note the smell. Excess
for presence of (Male) -Risk for Fluid
tenderness and note -Shine a light on the posterior Volume Excess
COLDSPA. part of the scrotum and -Sexual
Percussion visualize the testicles. Dysfunction
-Ask pt to sit and Palpation -Ineffective
place non-dominant (Female) Sexuality Pattern
hand over kidney. -Palpate for presence of -Situational Low
Make a fist with the masses. Self Esteem
dominant hand and (Male)
strike non dominant -Palpate scrotum and note its
hand noting any descend and presence of
pain. hernias.
M -Do you have any
U back problems?
S -Have you ever
C been told you had a
U spinal problem?
L -Assess for pain
O upon movement
S (COPLDSPA).
K -Arm muscle measurement and
E Palpation
L -Assess tenderness
E upon palpation.
T compare with other leg.
A -Inspect curvature of the spine.
L -Inspect joint for any
System
Neurologic -How would you
System describe your
mood?
-Do you feel any
numbness?
Inspection - Activity
-Inspect posture, symmetry, Intolerance
body size and irregularity in -Risk for Activity
shape of the whole Intolerance
musculoskeletal system as well -Risk for Falls
as any limitation in movement. -Fatigue
-Neck muscle symmetry, range -Impaired Physical
of motion and size. Mobility
-Risk for Injury
compare with other arm, also
test range of motion.
-Leg muscle measurement and
deformities.
Palpation
-Palpate all joins for any joint
deformities.
-Palpate for any abnormal
growth/protrusion of bone,
crepitus in the whole system.
-Check the range of motion in
all joints and note for any
limitation of movement.
-Palpate muscle `for presence
of any masses.
-Note muscle strength of all
four limbs (5/5), including
fingers or phalanges / tarsals
and metatarsals and elbows or
knees, neck, waist. Indicate
muscle strength with and
without applying resistance.
Cerebellar, motor -Unilateral Neglect
a. Balance -Impaired Physical
-Let the patient do heel to toe Mobility
walking. -Disturbed Sensory
-Let the patient stand closing Perception
the eyes and observe for -Risk for Injury
swaying of arms. -Risk for Fall
-Let the patient hop in one foot
then the other
finger to nose alternate with
other arm (open and close
eyes).
-From my hand to nose.
-Pronation and supination of
both hands.
-Fingers to thumb.
-Feet to my hand.
-Heel move from anterior knee
to feet.
b. Strength

-Arm strength with and

without resistance.
-Squeeze fingers.
-Leg strength with and without
resistance.
Sensory (comparing with other
side of body).
-Soft cotton sensation all over
body moving from distal to
proximal.
-Sharp and dull sensation
-Vibration feeling of a tuning
fork. Tell when it stops.
-Moving fingers up and down.
Identify direction while eyes
are closed.
-Identifying numbers of
pricking pins.
-Identifying number of hands
holding.
-Identifying objects whether
coin or pencil.
Reflexes
-Biceps tendons (clenched
teeth).
-Triceps tendons.
-Brachioradialis tendon.
-Patellar tendons (grasp
hands).
-Achilles tendon.
-Babinski reflex.
-Abdominal reflex.
Cranial nerves
I – Olfactory – identify
 different scents
II – optic – visual acuity,
visual field, fundoscopic exam
III – Occulumotor , IV –
trochlear and VI – abducens -
eye movement , pupilary
reflexes (PERRLA),
V – Trigeminal – sensations of
face using soft and sharp
objects, corneal reflexes with
wisp of cotton
VII – Facial – make faces,
open eyes against resistance
VIII – Acoustic – test hearing
acuity using tuning fork and
whisper test
IX – Glossopharyngeal and X
vagus – taste buds test - test
bitter taste last as this
interferes with the different
tastes, watch uvula rising,
check gag reflex
XI – Spinal accessory muscle
shoulder strength, tongue
XII – Hypoglossal – tongue
strength
Lymphatic / -Have you been Inspection -Infection
Hemato-logic tired? -Inspect any enlargement of -Risk for Infection
System -Do you have any the limb due to lymphatic -Risk for Fluid
lumps in your neck, obstruction. Volume Deficit
underarms or groin? -Inspect skin for signs of -Body Image
Palpation paleness or flushed Disturbance
-Palpate nodes for appearance.
presence of pain. -Assess for signs of bleeding in
the different areas of the body
including the oral mucosa,
nose and rectal bleeding by
noting the stool color. Also
inspect the skin for easy
bruising, petechial rashes,
ecchymosis and other bleeding
tendencies.
Palpation
-Palpate for enlargement of the
lymph nodes.
NOTE: Create a nursing diagnosis here based on the abnormal findings you have
identified. You can write as many nursing diagnosis as you can. More nursing diagnosis
will mean more points