ENDOCRINE SYSTEM 3.

Explain the procedures : to alleviate anxiety and

promote cooperation
Preparatory Phase In community/health center: explain
1. Prepare reflex hammer with the other necessary in their cognitive level
materials.
2. Explain the procedure to the client. 4. Perform Physical Assessment in orderly
3. Take the height and weight. sequence/manner: cephalocaudal, IPPA
4. Assist the client in a sitting position. 5. Position client: sitting, supine (30-45), left lateral
(heart comes close to chest wall)
Inspection and Palpation 6. Inspection:
5. Inspect the skin for hyperpigmentation (Addison’s a. NECK AREA: warm, neck vein engorgement
disease); hypopigmentation (seen in patients with Locate: jugular vein
Diabetes Mellitus); yellow cast of skin
(Hypothyroidism); purple striate over abdomen AF: > distented jugular vein: congestive heart
and bruising (Cushing syndrome)
failure (too much blood
6. Palpate the skin for texture, moisture and the
presence of lesions (rough and dry skin in
Hypothyrodism); smooth and flushed skin (in volume in the body)
Hyperthyroidism and lesions)
> pulsation
7. Assess the nails and hair as to texture and
condition, increased pigmentation of nails b. CAROTID ARTERY: use finger pads (index
(Addison’s Disease); dry, thick, brittle nails and and middle finger)
hair (Hyperthyroidism); excessive facial, chest and Location: between trachea,
abdomen hair (Cushing syndrome) jawline, sternocleidomastoid

8. Inspect the symmetry and form of the face, Note: > rate: # of beats (60-
position of the eyes (variations indicate 100bpm)
Acromegaly), protruding eyes (Hyperthyroidism)
> rhythm:
Thyroid Gland
9. Palpate the thyroid gland for size and consistency; regular/irregular
a. Stand behind the client and place the fingers
on either side of the trachea below the thyroid > amptitude: strong and
cartilage. weak pulsation bounding

b. Ask the client to tilt his/her head to the right. AF: use ball of the hand

c. Ask the client to swallow, as he/she swallows Thrills – turbulent blood

displace the left lobe while palpating the right flow of the area
lobe.
Pulsation –
d. Repeat and palpate the left lobe (enlarged
with Grave’s Disease; multiple nodules in 7. Identify various area: use finger pad
Metabolic Disorders; presence of nodules may Palpate: Aortic Area – 2nd right ICS parasternal
indicate a cyst, or benign or malignant tumor)
border
Musculoskeletal Structure
10. Inspect the size and proportion of the client’s Pulmonic Area – 2nd left ICS parasternal
body structure (Short stature indicates Dwarfism; border
large bone indicates Acromegaly)
Erb’s point area – 3rd left ICS parasternal
Hypocalcemic Tetany border

Assess for Trousseau’s Sign Tricuspid Area – 4th-5th left ICS

11. Inflate the pressure cuff above antecubital space
to occlude blood supply to the arm (Carpal Spasm
indicates low calcium level)
Assess for Chvostek’s Sign
12. Tap the finger in front of the client’s ear at the
angle of the jaw (contraction of the lateral facial
muscles indicates decreased calcium levels)
parasternal border
Mitral or Apical Area – 5th left
midclavicular area/near nipples/point of maximal point
Epigastric pulse: below xiphoid process;
pulsation ( aortic valve)

Cardiovascular System AF: thrills vibrations

1. Prepare necessary equipment – stethoscope and Note: rate, rhythm of pulses

wristwatch
2. Provide adequate lighting.
 8. Identify heart sound: use stethoscope: 11. Liver – right midclavicular area (upward); – below
Auscultate: Intensity , characteristics, rate and umbilicus – liver
rhythm, timing, pitch, regularity 12. Outline boundary of liver dullness
a) Midsternal ine
S1 : Apex of the heart “LUB” ; closure b) Right midclavicular line
of tricuspid and mitral valve 13. Stomach – tympany of gastric bubble – lower
anterior ribs
14. Spleen – left lower anterior chest, changes from
S2 : Base of the heart “DUB” ;
tympany to dullness
closure of aortic and pulmonic valve PALPATION
15. Light palpation – ribs of fingers – light dip
a) Muscular resistance.guarding
b) Abdominal tenderness
S1 low pitch; shorter sound c) Superficial organs
d) Mass
S2 high pitch; longer sound 16. Deep palpation – palmar surface – 4 quadrant
masses and organomegaly – identify
 Location, size, shape, consistency,
tenderness, pulsation, mobility
AF: Timing and pitch 17. Liver
a) Left hand, behind, support right
S3 ventricular gallop; Heart failure, 11th and 12th ribs
MI; heard after S2; “Kentucky” b) Press left hand – liver
c) Check liver  tenderness, contour,
S4 atrial gallop; hypertension, Aortic size and shape
stenosis, MI; heard before S1; “Tennessee” 18. Spleen
a) Right palm on abdominal wall (LUQ), tips of
Friction rub gallops index and middle finger on inferior to rib
margin – left anterior axillary line
Carotid artery b) Left palm on left midaxillary region of thorax,
support thoracic wall (11th and 12th ribs)
AF: use diaphragm: BRUIT (hold 1-2 c) Right fingers push posteriorly and upward
seconds) behind the costal margin (x - spleen)
d) Check for: tenderness, size
GASTROINTESTINAL SYSTEM

1. Prepare the client

a) Explain procedure, “relax”
LOWER GIT (Anus and Rectum)
b) Empty bladder
2. Self: short fingernails, warm hands, stethoscope
INSPECTION AND PALPATION
3. Good lighting, privacy
4. IAPP sequence
Male client
a) Inspect: Sacro-coccygeal and perianal
UPPER GIT
areas – lumps, inflammation, rashes or excoriation
b) Lubricated and gloved index finger – anus
INSPECTION
c) Insert fingertip – anal area – pointing to
5. Abdomen
umbilicus
a) Skin: scars (location and size), striae (size and
d) Lesions, tone of sphincter, tenderness,
color), dilated veins (fine venous network),
nodules, blood & characteristic of stool – finger
rashes & lesions, petechiae, glistening taut
skin
Female Client
b) Umbilicus: contour, shape, location,
a) Lithotomy position
inflammation, discharge/drain
b) Inspect: Sacro-coccygeal and perianal areas –
c) Abdomen: contour (flat, rounded, protuberant,
lumps, inflammation, rashes or excoriation
scaphoid, concave), symmetry, mass, visible
c) Lubricated and gloved index finger – anus
peristalsis, pulsation (epigastrium)
d) Letter (c)
AUSCULTATION
e) Letter (d)
6. Listen – quadrants and regions – right lower
quadrant (ileocecal valve) – clockwise
MUSCULOSKELETAL SYSTEM
7. Characteristic and frequency of bowel sounds
(soft clicks and gurgles) – 1 minute
1. Prepare the equipment needed for physical
8. Bell – vascular sounds; bruits (turbulent blood
examination (tape measure, goniometer – to
flow) – aneurysm or partial obstruction of a vessel
measure joint angles, skin marking pen)
9. Liver and spleen – friction rubs, hepatic tumor and
2. Follow an orderly manner of examination
splenic inflammation
(cephalocaudal manner – IPPA, ROM, muscle
PERCUSSION
testing)
10. Percuss – abdomen quadrants
a) General proportions
TEMPOROMANDIBULAR JOINT
b) Distribution of tympany and
Inspection
dullness
 3. Inspect the area anterior to the ear for any
swelling or redness.
4. Ask the client to open mouth maximally and
measure the space vertically (normal range is 3-6
cm or 3 fingers inserted sideways)
Palpation
5. Palpate each side of temporomandibular joint for
swelling or tenderness (place the tip of your two
fingers in front of each ear and ask the client to
open and close mouth. Drop your fingers into the
depressed area over the joint and palpate for any
bulges over the joint).
6. Palpate the contracted temporalis and masseter
muscle as you ask the client to clench his/her
teeth. Compare right and left sides for size,
firmness and strength.
7. Note for the movement of the temporomandibular
joint (an audible sharp or click occurs in many
normal people as the mouth opens).
8. Ask the client to partially open mouth, then
protrude lower jaw and move it side to side, then
stick out lower jaw.
Muscle Strength
9. Ask the client to move jaw forward and laterally,
open mouth against resistance.
CERVICAL SPINE
Inspection
10. Inspect the alignment of head and neck (spine
should be straight and head erect). Note for any
deformity.
Palpation
11. Palpate the spinous process and the
sternocleidomastoid, trapezium andparavertebral
muscles from behind the patient. Note for any
muscle sparm or tenderness.
12. Ask the client to do the following motions:
a. Touch his/her chin to chest
(flexion)
b. Lift the chin toward the ceiling
(extension)
c. Touch each ear toward the
corresponding shoulder. Do not lift up the
shoulder (lateral bending).
d. Turn the chin toward each
shoulder (rotation)
Muscle Strength
13. Repeat the motions done in examining ROM while
applying opposing force (Normally, a person can
oppose resistance applied)
THORACOLUMBAR SPINE
Inspection
14. While the patient is in standing position, note for
gross deformity, muscle atrophy, local swelling,
abnormal curvature (lateral deviation).
Palpation
15. Palpate for tenderness, hardened muscle for
spasm.
Percussion
16. Percuss each spinous process with finger or
rubber hammer for tenderness.
Muscle Strength
17. Direct the patient to flex, extend, laterally bend
and rotate spine.
18. Repeat above while applying opposing force.
UPPER EXTREMITIES
Inspection
19. Inspect and compare both shoulders posteriorly
and anteriorly. Check for the size and contour of
the joint and compare shoulders for equality of
bony landmarks. Check the anterior aspect of the
joint capsule and the subacromial bursa for any
swelling.
20. Inspect for the size and contour of the elbow in
both flexed and extended positions for any
deformity, redness or swelling.
21. Inspect the hands and wrist on the dorsal and
palmar sides, noting position, contour and shape.
Palpation
22. While standing in front of the client, palpate both
shoulders noting any muscular spasm or atrophy,
swelling, heat or tenderness.
23. Palpate the elbow flexed about 70 degrees and as
relaxed as possible. Palpate the olecranon process,
olecranon bursa, medial and lateral epicondyles of
humerus, using varying pressures (normally
present tissue and fat pads feel fairly solid). Note
for any synovial thickening, swelling, nodules or
tenderness.
24. Palpate each joint in the wrist and hands,
metacarpophalangeal joints, interphalangeal joints
and identify the normal depressed areas that
overlie the joint space. Use gentle but firm
pressure. Take note of any swelling, bogginess,
nodules or tenderness.
Percussion
25. Direct percussion on the location of the median
nerve at the wrist (Client should not feel anything
upon percussion) – Tinnel’s sign. Note for any
limited movements, pain, tenderness of the
extremities.
26. Cup one hand over shoulder during ROM and take
note of any crepitation.
27. Ask the client to perform four motions:
a. With arms at sides and elbows
extended, move both arms forward and up
in wide vertical arcs. Then move them
back.
b. With arms at sides and elbows
extended, raise both arms in wide arcs in
the coronal plane. Touch palms together
above the head.
c. Touch both hands behind the head,
with elbows flexed and rotated posteriorly.
28. Elbow – ask the client to perform the following
motions:
a. Bend and straighten the elbows
b. Hold the hand midway, then touch
front and back side of hand to the table.
29. Wrist and Hand – Ask the client to do the motions
for testing the ROM of hands and wrists.
a. Bend the hand up the wrist
b. Bend the hand down at the wrist
c. Bend the fingers up and down at
the MCP joints
d. With palm flat on the table, turn
them outward and in
e. Spread fingers apart; make a fist
 f. Touch the thumb to each finger
and to the base of the little finger
Muscle Strength
(Upper Extremities)
30. Test the muscle strength by asking the client to
do the following:
a. Shrug the shoulders
b. Flex forward and up, abduct
against resistance
c. If muscle damage is suspected in
the rotator cuff, abduct the client’s arm
and ask the client to lower it slowly
(normally arm lowers slowly)
(Elbow)
31. Stabilize the client’s arms with one hand, then
have the client flex the elbow against your
resistance applied just proximal to the wrist. Then
ask the client to extend the elbow against
resitance.
(Wrist and Hand)
 Position the client’s forearms supinated (palm up)
and resting on a table. Stabilize by holding your
hand at the client’s mid forearm.
32. Ask the client to flex the wrist against your
resistance at the palm.
33. Ask the client to hold both hands back to back
while flexting the wrist 90 degrees (acute flexion
of the wrist for 60 seconds produces no symptoms
in the normal hands) – Phalen’s test.
LOWER EXTREMITIES
Inspection
34. Inspect the skin of the lower extremities (skin
normally looks smooth, with even coloring and
free of lesions).
35. Inspect for leg alignment, shape of the knees and
contour, note for swelling or fullness.
36. Inspect the quadriceps muscle in the anterior
thigh for any atrophy.
37. Inspect the ankle and foot when client is in a
sitting position, non-weightbearing position, as
well as standing and walking. Compare both feet,
noting position of feet and toes, take note of the
contour of joints, and skin characteristics. Note for
locations of any calluses or bursal reactions.
38. Inspection of the hip joint together the spine as
the client stands. Note for the symmetric levels of
iliac crests, gluteal folds, size of the buttocks.
Palpation
39. Position the client in a supine position. Palpate the
hip joints for any tenderness or swelling (joints
should feel stable and symmetric, with no
tenderness or crepitance).
40. Palpation of the knee is done in a supine position.
Start high on the anterior thigh (about 10 cm
above the patella). Palpate wit thumb and fingers
in grasping fashion. Proceed down toward the
knee, exploring the regions of the suprapatellar
pouch. (Take note of the consistency of the
tissues, the muscles, and soft tissues, and
smoothness of the joints. Take note also for any
tenderness, roughness of the muscles,
temperature, thickening or nodularity).
41. Palpate the tibiofemoral joints. Take note of the
texture of the joint margins, tenderness, check for
crepitus.
42. Palpate the joint spaces of ankle and foot noting for
any fullness, swelling or tenderness.
43. Palpate the metatarsophalangeal joints and
interphalangeal joints with your thumbs and
fingers. Note for the temperature, swelling or
tenderness.
44. Palpate the spinous processes and the
paravertebral muscle for tenderness or spasms.
Note for any limited movements, pain and tenderness
of the extremities.
Hip
Ask the client to perform the following:
45. Raise each leg with knee extended (hip flexion of
90 degrees)
46. Bend each knee up to the chest while keeping the
other leg straight (hip flexion of 120 degrees. The
opposite thigh should remain on the table).
47. Flex knee and hip to 90 degrees (stabilize by
holding the thigh with one hand and the ankle with
the other hand. Swing the foot outward and inward
– foot and thigh move in opposite directions).
48. Swing leg laterally, then medially, with knee
straight. (Stabilize pelvis to eliminate exaggerated
lumbar lordosis. The most efficient way is to ask
the client to bend over the table and to support the
trunk on the table. Or the client can lie prone on
the table).
Knee
Ask the client to do the following:
49. Bend each knee (flexion is 130 to 150 degrees)
50. Extend each knee and check knee ROM during
ambulation.
Ankle and Foot
Ask the client to perform the following motions:
51. Point toes toward the floor (plantar flexion of 45
degrees)
52. Point toes toward the client’s nose (dorsiflexion of
20 degrees)
53. Turn soles of feet out, then inward (stabilize the
ankle with one hand, hold heel with the other to
test the subtalar joint) – (eversion of 20 degrees
and inversion of 30 degrees)
54. Flex and straighten toes
Spine
Ask the client to:
55. Bend forward and touch the toes (look for flexion of
75 to 90 degrees and smoothness and symmetry
for movement. The concave lumbar curve should
disappear with this motion and the back should
have a single convex C-shaped curve).
Stabilize the pelvis of the client with your hands. Then ask
the client to:
56. Bend sideways (lateral bending of 35 degrees)
57. Bend backward (hyperextension of 30 degrees)
58. Twist shoulders to one side, then the other
(rotation of 30 degrees bilaterally)
Muscle Strength
Lower Extremities
59. Ask the client to maintain knee flexion, while you
oppose by trying to pull the leg forward.
NERVOUS SYSTEM
 Ask the patient to write his name on a page of blank paper.
A. Techniques of Neurological Examination Then ask him to copy some figures drawnby the examiner
Organize your thinking into six (6) major categories: on the page including a circle, cross, square and diamond
1. Cerebral function and a row of dots.
2. Cranial nerves
3. Motor system 1.6.6. Testing Specific Functions which includes:
4. Sensory system
5. Reflexes 1.6.6.1. Cortical Sensory Interpretation
6. Cerebellar Refers to the ability to recognize objects through different
senses
B. Physical Examination
1.6.6.1.1. Visual perception
1. Test for Cerebellar Function “Find it” e.g. “We are going to play a game to see how
1.1.Over-all appearance, behavior, psychomotor good you are in finding things. I’m going to put these 6
activity, attitude towards the examiner things out of my desk and when I name one you have to
1.2.Level of consciousness hand me the object.”
1.2.1. Level I – Alert
1.2.2. Level II – Lethargy, somnolence, 1.6.6.1.2. Stereognosis
drowsy Ability to recognize an object from its feel and can also be
1.2.3. Level III – Obtundation assessed through games.
1.2.4. Level IV – Stupor Ask the patient to close both eyes and put one of the 3
1.2.5. Level V - Coma things in the patient’s hands and take it back, upon
1.3.Mood and affect opening the eyes ask the patient what object it is.
1.4.Speech (quantity, quality, rate of production)
1.5.Thought process and perception 1.6.6.1.3. Graphestesia
1.5.1. Note coherency and the
 Ability to identify shapes by outlines drawn on the
relevance of thought processes
skin (palm of hand)
1.5.2. Note the thought content and inquire
about compulsions, obsessions, ruminations,
1.6.6.1.4. Kinestesia
doubting and indecision, phobias and free-floating
anxieties  Ability to perceive direction of movement.
1.5.3. Note for perceptual disturbances such as
hallucinations, illusions, delusions 1.6.6.1.5. Texture discrimination
1.6. Cognitive Functions  Ability to perceive “roughness” or “smoothness”
1.6.1. Note orientation to time, place, person
1.6.2. Note the attention and concentration that 1.6.6.1.6. Auditory Agnosia
includes attention span  Is tested by having the client close his/her eyes
1.6.3. Memory and identify sounds such as sound of a bell or clap

1.6.3.1. Brief Retention 1.6.6.2. Cortical Motor Integration

Test of an idea, sound, or object  Can be tested by having the client perform a semi-
e.g. Client will listen and repeat 4,2,1 skilled task such as folding a piece of paper and
sealing it in an envelope.
1.6.3.2. Recent Memory
Show an object and tell client that you will ask him to tell
you afterwards, after 5 minutes.
1.6.6.3. Language
Later ask him to recall what was the object.
 Both spoken or written is a specific function of
1.6.3.3. Remote Memory certain areas in the cerebral cortex.
Ask the patient what he had for dinner.
2. TEST FOR CRANIAL NERVES
1.6.4. Vocabulary
2.1.First Cranial Nerve (Olfactory)
Ask the patient to give you the meaning of the following
 Be sure that both nasal passages
words or to use the words in a sentence.
are patent.
1.6.5. Abstract Reasoning  Ask the client to close his eyes.
Tested in 2 ways: by noting the relevance to the answers,  Test each nostril by occluding the
and by their degree of concreteness or abstractness opposite side. Ask the patient to
identify odors. Use coffee, soap or
vanilla.
2.2.Second Cranial Nerve (Optic)
1.6.5.1. Similarities 2.2.1. Test for visual acuity
Ask the patient to tell you how the following are alike (e.g.  Ask the patient to read any
an orange and an apple) available print by using each eye
1.6.5.2. Judgement separately, covering the other with
an opaque card.
Noting the patient’s judgement with respect to his
2.2.2. Test for papillary reactions
personal life (e.g. “What should you do if you use a
librarybook?”)  Inspect the size and shape
1.6.5.3. Sensory Perception&Coordination of the pupils, and compare one
side with the other. Test the
 reaction to light using a penlight
(Test for CN II and III)
2.3.Third, Fourth and Sixth Cranial Nerve
(Occulomotor, Trochlear and Abducens)
 Test the extraocular movements
in the six cardinal directions of gaze,
and look for loss of conjugate
movements in any of the six
directions.
 Identify ptosis and nystagmus
2.4.Fifth Cranial Nerve (Trigeminal)
2.4.1. Motor
 While palpating the
temporal and masseter muscle,
ask the client to clench his/her
teeth. Note the strength of the
muscle contraction, jerky
movement and mastification.
2.4.2. Sensory
 With the client’s eyes
closed, test the forehead, cheeks
and jaw on each side for pain
sensation.
 Use a safety pin,
occasionally alternating the blunt
and pointed end as a stimulus.
Ask the client to report whether it
is sharp or dull to compare sides.
2.4.3. Test for the corneal reflex
 Ask the client to look up,
approaching from side and
avoiding the eyelashes, touch the
cornea lightly with a wisp of
cotton.
 Note tearing and blinking.
2.5.Seventh Cranial Nerve (Facial)
 Inspect the face, both at rest and
during conversation, note any
asymmetry, and or other abnormal
movements; ask the patient to:
a. Raise his/her eyebrows
b. Frown
c. Close eyes tightly so that
you cannot open them
d. Show his/her teeth
e. Smile
f. Puff out his/her cheeks
2.6.Eight Cranial Nerve (Acoustic)
 Assess hearing by whisper test;
testing lateralization and comparing
air and bone conduction.
2.7.Ninth and Tenth Cranial Nerve
(Glossopharyngeal and Vagus Nerve)
 Ask the client to say “ah” or yawn;
observe the upward movement of the
soft palate and uvula and the inward
“curtain” movement of the posterior
parynx; identify any asymmetry
 Stimulate the back of the throat
lightly on each side in turn and note
the gag reflex
2.8.Eleventh Cranial Nerve (Spinal Accessory
Nerve)
 Ask the patient to shrug both
shoulders upward against your hands.
 Note the strength and contraction
of the trapezius muscle.
 Ask the patient to turn his/her head
to each side against your hand.
Observe the contraction of the opposite
sternocleidomastoid and note the force
of the movement against your hand.
2.9.Twelfth Cranial Nerve (Hypoglossal)
 Inspect the client’s tongue as it lies
in the floor of the mouth.
 Note for any fasciculations. then,
with the client’s tongue protruded, look
for symmetry, atrophy, or deviation
from the midline.
3. MOTOR SYSTEM
3.1.Assessment of Muscle Tone
 Persuade the client to relax. Take
one hand with yours and while
supporting his/her elbow, flex and
extend the client’s fingers, wrist and
elbow and put his/her shoulders
through a moderate range of motion.
 On each side, note his muscle tone
3.2.Testing Muscle Strength
 Test muscle power against
resistance, against gravity only or with
effects of gravity removed.
 On each side, try to depress his/her
outstretched arms against resistance,
note his/her strength and watch the
scapula on the side for winging or
displacement suggesting a weak
serratus anterior muscle.
 Test for flexion and extension of
the elbow by having client pull and
push against your and.
 Test dorsiflexion at the wrist by
asking the client to make a fist and
resist your pulling it down.
 Test for the grip by asking the
client to squeeze two of your fingers as
hard as possible and not let them go.
 Ask the client to spread his/her
fingers, check abduction by trying to
force them together.
 Ask the patient to touch the tip of
the little finger with a thumb against
your resistance.
 Test abduction of the hip by
placing your hands firmly on the bed
outside the patient’s knees. Ask the
patient to spread both legs against our
hands.
 Test flexion and extension of the
knee. Flexed with foot resting in the
bed. Ask the client to keep his/her foot
down and straighten his/her legs
against your hands.
 Test for plantar flexion and
dorsiflexion at the ankle by asking the
client to push down and pull up against
your hands.
4. SENSORY SYSTEM stretched and strike the tendon briskly,
producing a sudden additional stretch.
4.1.When testing sensation 5.1.2. Hold the reflex hammer between
4.1.1. Note the client’s ability to perceive thumb and finger so that it swings
the stimulus. freely in an arc, yet controlled in its
4.1.2. Compare the symmetrical areas on direction. If the client’s reflexes are
the two sides of the body. symmetrically diminished or absent,
4.1.3. Compare distal with the proximal use reinforcement.
areas of the extremities when testing
pain, temperature and touch. Initiate 5.2.Test for Reflex status
testing of vibration and position sense 5.2.1. Deep Reflexes
distally.  The deep reflexes are
4.1.4. Scatter the stimuli so that you cover elicited by tapping briskly on a
most of the dermatomes and major tendon or a bony prominence,
peripheral nerves. evoking the following reflexes:
4.1.5. When you detect an area of sensory a. Biceps
loss or hypersensitivity, map out its b. Brachioradialis
boundaries in detail. c. Triceps
d. Patellar
e. Achilles
4.2.Ask the client to close his/her eyes, test 5.2.2. Superficial Reflexes
sensation of the arms, trunk and legs using  These are tested by
the following stimuli: stroking the skin with an object
4.2.1. Pain – use a safety pain, occasionally that is moderately sharp but not
substituting the blunt end for the sharp enough to break the skin.
point. Ask the client to report whether a. Upper abdominal –
it is sharp or dull. umbilicus moves upward
4.2.2. Temperature – use 2 test tubes filled and towards the area being
with hot and cold water. Touch the stroked.
skin, and ask the client to identify b. Lower abdominal –
“hot” or “cold”. umbilicus moves down
c. Cremasteric –
4.2.3. Light Touch – use a fine wisp of
scrotum elevates
cotton. Ask the client to respond
d. Plantar – flexion of
whether you touch his/her skin.
toes
4.2.4. Vibration – Place a tuning fork firmly e. Gluteal- skin tenses
over a distal interphalangeal joint of at gluteal area
the big toe. Ask what the client feels. 5.2.3. Babinski – Stroke the lateral aspect of
4.2.5. Position – Grasp one of the client’s the sole from the heel to the ball of the
fingers, holding its sides between your foot, curving medially across the ball.
thumb and index finger, then move it Dorsiflexion of the big toe and fanning
up or down. of the other toes means a positive
Babinski reflex.
4.2.6. Discriminative Sensations
4.2.6.1. Number Identification – 6. CEREBELLAR FUNCTION
With a blunt end of a pen or
pencil, draw a large number in the 6.1.Gait
client’s palm. Ask the client to  Ask the client to walk across the
identify what number it is. room, preferably down the hall, turn
4.2.6.2. Two-point discrimination – and come back. Observe the posture,
Using the sides of 2 pins, touch balance, the swimming of the arms and
the skin simultaneously. Alternate movements of the legs.
the stimulus irregularly with one 6.2.Romberg’s Test
point touch. Find the minimal  Ask the client to stand with his/her
distance which the patient can feet together. Note his ability to
discriminate one from two points. maintain an upright posture, first with
4.2.6.3. Point Localization – Touch his eyes open, then with his eyes
a point on the clients’ skin. Ask closed.
him/her to open his/her eyes and
point to the place touched. 6.3.Pronator Drift
 Ask the client to close his/her eyes
4.2.6.4. Extinction –
and for 20-30 seconds, hold his/her
Simultaneously stimulate
arms straight in front of him/her. With
corresponding areas on both sides
palms up, watch how well he/she
of the body.
maintains this position.
6.4.Assessing Coordination
5. REFLEXES
6.4.1. Coordination in the arms may be tested
6.4.1.1. Rapid Rhythmic Alternating
5.1.To elicit a deep tendon reflex
Movement – Test each hand
5.1.1. Persuade the client to relax, position
separately, ask the client to:
the limbs so that the muscle is mildly
 a. Pat his/her hand as fast as
he/she can with his/her hands
b. Turn his/her hand over and
back as rapidly as he/she can
c. Touch each of his fingers with
his/her thumb in rapid
sequence
d. Note for any awkwardness of
the movement
6.4.1.2. Point to Point Testing
 Ask the client to touch
your index finger then his/her
nose alternately several
times. Note any awkwardness
or tremor then repeat the
maneuver with the client’s
eyes closed.
6.4.2. Assessing the Coordination in the legs
6.4.2.1. Rapid Rhythmic Alternating
Movement
 Ask the client to tap your
hand rapidly or quickly as
possible with the ball of each
foot in turn, note any
slowness or awkwardness.
6.4.2.2. Point to Point Testing
o Ask the client to place his/her heel on the
opposite knee, then run down his/her shin
to the foot. Note any tremor or
awkwardness (e.g. Ataxia).
URINARY SYSTEM
1. Prepare the equipment like specimen cup,
disposable gloves.
2. Provide gown and maintain privacy when
necessary.
3. Collect clean catch urine specimen; assess for
color, odor and clarity before sending to the
laboratory.
INSPECTION
1. Inspect the skin and the mucous
membrane (note color, turgor)
2. Inspect the abdomen. Help client assume
a supine position (note for the size, symmetry
swelling, prominent veins, distention, glistening or
skin tightness)
3. Inspect the urinary meatus. (Not a part of
a routine but an important component with
problems in the urinary system)
Male:
 Help the client assume a sitting or standing
position.
 Compress the tip of the glans penis with gloved
hand to open the urinary meatus.
Female:
 Assist the client assume a dorsal recumbent
position.
 Spread the labia with gloved hand to expose the
urinary meatus.
PHYSICAL ASSESSMENT OF THE KIDNEYS
AUSCULTATION
1. Auscultate the renal arteries.
2. Help the client in a supine position.
3. Place the bell of the stethoscope lightly in the
areas of the renal arteries, located in the left and
right upper abdominal quadrants (systolic bruits
like whooshing sounds indicate renal artery
stenosis)
PERCUSSION
For Indirect Percussion
1. Assist the client into a sitting position and stand
behind the client.
2. Place the palm of the non-dominant hand over the
costovertebral angle.
3. Strike this area with ulnar surface of your dominant
hand, curled into fist. Repeat the technique on the
other kidney.
For Direct Percussion
4. Strike the area over the Costovertebral angle with
the ulnar surface of your hand, curled into a fist
(tenderness may indicate glumerulonephritis or
pyelonephritis).
5. Repeat the technique on the other kidney.
Pointers to take note in performing percussion of the
kidneys
a. Perform percussion with enough force so that the
client feels a gentle thud.
b. Percussion is done at the end of the assessment.
URINARY BLADDER
1. Palpate the bladder for distentin.
2. Gently palpate over the symphysis pubis and
abdomen (distended bladder may be palpated at
any point from symphysis pubis to the umbilicus
and is felt as a firm, rounded organ)
3. Percuss the bladder for tone and position.
4. Help the client assume a supine position (Dull
percussion tone over the bladder of a client who
had just urinated may indicate urinary retention)
IMMUNE SYSTEM
- Review biographic data of the client
a. Age
b. Sex
c. C. Race
d. Ethnic background
e. Family medical history
- Assess general appearance – does the age coincide
with the appearance?
- Note fatigue or weaknesses
- Note the height, weight and body type of the patient
o Apparent weight loss or body wasting
- Observe the client’s ease for movement – note for
evidence of stiffness or difficulty in moving
- Check vital signs – Temp, BP, RR, PR
- Assess skin color, temperature and moisture
 o Pallor – indicates bone marrow suppression
o Pale – decreased blood
- Inspect skin for rashes, lesions, petechieae, numerous
bruises, purple or blue patches (may indicate caposis
sarcoma), infected wounds – inflamed or unhealed
- Note location and distribution of rashes and lesions
- Inspect the color and condition of the mucus
membrane of nose and mouth (using penlight)
- Inspect and palpate cervical lymph nodes
- Assess musculoskeletal system by inspecting and
palpating joints for redness, swelling – rheumatitis
- Check range of motion of joints including that of the
spine
o Ratio of anteposterior and
transverse diameter is 1:1
9. Palpate for bulges, tenderness, painful areas and
abnormal movements
10. Respiratory Expansion
- Result: full symmetric chest expansion =
divergence
- Unilateral delay / lag = not symmetrical
11. Vocal or Tactile Fremitus  “99”
- For lateral thorax – use ulnar side of hand
12. Percuss thorax
- To determine whether lung tissue is filled with air,
liquid or solid material
- Percuss ICS at about 5cm / 2in intervals

RESPIRATORY SYSTEM - If posterior, ask patient to fold arms across the

chest
1. The usual…
- Area of Resonance – over the lungs
- Identify the patient and explain the
- Area of Dullness – over the organs
procedure
o Heart is in the 3rd– 5th L ICS
- Prep environment, provide privacy, hand
hygiene
13. Auscultate Chest  diaphragm
- Prepare equipment – stethoscope! 14. Normal Breath Sounds:

2. Inspect the shape and configuration of the chest - Vesicular – heard over lungs; I>E

wall - Bronchial – heard over trachea; I<E

3. Note the breathing pattern and position - Bronchovesicular – heard over the scapulae and
4. Note for any manifestations of respiratory 1st-2nd ICS; I=E
distress: 15. Adventitious Breath Sounds
- Grasping - Crackles
- Grunting - Ronchi
- Central cyanosis - Friction Rub
- Flared nostrils - Wheezes
- Open mouth
- Dyspnea
5. Note the rate, rhythm, depth and effort of
breathing
- Rate: 12-20 breaths / minute
6. Inspect the use of accessory muscles
7. There should be no retraction of supraclavicular
areas during inspiration (intercostals retraction)
8. Note the Shape of chest (deformities) :
- Pigeon Chest
o Narrow transverse diameter
o Protruding sternum
- Funnel Chest
o Narrow anteposterior diameter
o Depressed sternum
- Barrel Chest