SYSTEMATIC PHYSICAL APPRAISAL : A HEAD TO TOE APPROACH

I. GENERAL SURVEY. (60 seconds impression regarding immediate status of client on entering room)
a. Apparent state of health
b. Signs of Distress
c. Skin Color
d. Stature and body build, height and weight
e. Posture, motor activity and gait
f. Dress, grooming, and personal hygiene
g. Odors of body and breath
h. Manner, mood, and relationship with persons and things around client
i. Speech
j. State of awareness, consciousness
k. Presence of supportive or monitoring devices and their function
l. Facial expressions

II. VITAL SIGNS
a. Blood Pressure
b. Temperature
c. Radial Pulse
i. Quality
1. Equal on both sides
2. Thready, bounding, weak, strong
ii. Rhythm
1. Regular
2. Irregular- irregular
3. Irregular- regular
d. Respiration
i. Rate
ii. Rhythm
iii. Depth
iv. Ease
III. HEAD
a. Hair, Scalp, Skull
i. Texture, cleanliness, quantity, distribution, patterns of loss or gain of hair
ii. Scalp condition ( scaly, lumpy, other lesions)
iii. Skull contour, head circumference
iv. Condition of fontanels
b. Face
i. Facial expression
ii. Symmetry, involuntary movements, edema, lesions, masses
c. Eyes
i. Position and alignment of eyes
ii. Position of eyelids in relation to eyeballs
iii. Eyelid (ptosis, edema, lesions)
iv. Eyelashes (presence, direction of growth)
v. Eyes
1. Conjunctiva, sclera, color
2. Lens
3. Iris
4. Pupil (size pre-stimulatio n and post- stimulation, shape, equality, reaction to light and
accomodation)
vi. Visual fields by confrontation method (a method of perimetry; the examiner compares the
patient's visual fields with the examiner's own by facing the patient who has one eye
covered and the other fixed on the corresponding (confronting) eye of the examiner.
The examiner then holds a finger midway between them and moves it slowly in
different directions until the patient fails to see it. In each instance the finger is moved
again toward the original position until the patient can just see it.)
vii. Corrective or prosthetic devices
viii. Test range of extra ocular movement through six cardinal fields of gaze

d. Ear
i. Auricle color, lumps, lesions
ii. Patency of canal and color (use otoscope)
iii. Webers (Weber's test was developed to detect unilateral hearing loss) and Rinne test
( hearing test, primarily for evaluating loss of hearing in one ear (unilateral hearing loss))

e. Mouth
i. Lips ( color, moisture, lumps, ulcers, cracking)
ii. Mucous membranes ( ulcers, nodules, color, moisture)
iii. State of teeth and gums
iv. Tongue
1. Coated
2. Lesions ( inckuding floor of mouth, palpate if found)
3. Edema
4. Symmetry of movement
v. Tonsils, Uvula
1. Color, exudates
2. Edema
3. Symmetry
IV. NECK
a. Lymph Nodes
b. Jugula vein ( distention)
c. Carotid pulse (palpate)
d. Trachea ( inspect and palpate for deviation)

V. THORAX
a. Lungs
i. Inspection:
1. Shape of chest, deformity of thorax, spine contour, symmetry of chest expansion
2. Use of accesory muscles and retration of intercostal muscles
3. Presence of Cough
4. sputum
a. Color
b. Amount
c. Odor
5. Local lag or impairment of respiratory movement
6. Posiiton of comfort
ii. Palpation:
1. Distance of chest wall excursion
2. Tenderness around pain or lesions
3. Fremitus (the vibration intensity felt on the chest wall (tactile fremitus) and/or heard by a
stethoscope on the chest wall with certain spoken words (vocal fremitus)).
iii. Percussion:
1. Symmetry of chest wall sounds
2. Abnormal areas ( identify, localize, describe)
3. Diaphragmatic excursion
iv. Auscultation:
1. Presence of loudness of breath sounds throughout the lung fields (symmetry)
2. Breath sounds ( quality, intensity)
a. Vesicular
b. Brochial
c. Bronchovesicular
3. Adventitious sounds
a. Rales
b. Rhonchi, including wheeze
Note: Examination of respiratory system is done ANTERIORLY AND POSTERIOR
b. Heart
i. Inspection and Palpation:
1. Point of maximal impulse (PMI) location, amplitude
2. Pulsations over chest wall
ii. Pulsations over chest wall
1. Cardiac size
iii. Auscultation:
1. First and second heart sounds at aortic, pulmonic, mitral, tricuspid areas
2. Heart rate, rhythm
3. Apical, radial pulses
4. Extra sounds or murmurs
c. Breats
i. Inspection:
1. Female Clients:
a. Size, presence of edema, rashes, striae
b. Color ( pink, red, blue, deep brown)
c. Shape (round, pendulous, everted)
d. Inflammation, discharge, nipple crusting
e. Puckering, dimpling, flattening, enlarged pores, peau d orange
Note : Inspect as patient sits, raises arms over head, presses hands against hips.
2. Male Clients:
a. Nodes, swelling, ulceration
ii. Palpation: (periphery, nipple, areola)
1. Note consistency, induration, tenderness
2. Nodules ( size, location, shape, mobility, tenderness, consistency)
3. Elasticity of nipple