Physical Examination Definition It is examination of the

Physical Examination

Definition: It is examination of the body from the head to the toes, it is a continuous process that begins the interview primarily by using inspection, palpation, percussion and auscultation

Objectives of physical assessment -To formulate nursing diagnosis -To evaluate the effectiveness of intervention

Suitable time for physical examination: • Each month during the first year of life • Each 3 months during the 2 nd and 3 rd years • Each 6 months during the 4 th and 5 th years • Yearly from the 6 th year throughout life

Sequence of the assessment In adult the physical examination proceeds in a head to toe direction and from general inspection to detailed investigation In pediatrics, the age of the child frequently alters this sequence of performance

Assessment skills Inspection

Assessment skills Palpation

Assessment skills Percussion

Assessment skills Auscaltaion

Out lines of a physical assessment 1. Growth measurements Length, weight, head circumference, chest and arm circumference 2. Physiological measurements Temperature, pulse, respiration and blood pressure

3. General appearance 4. Skin 5. Accessory appendages 6. Lymph nodes 7. Head 8. Neck 9. Eyes 10. Ears 11. Nose 12. Mouth and throat 13. Chest, lung 14. Heart 15. Abdomen 16. Genitalia 17. Anus 18. Back and extremities 19. Neurological assessment

3. General appearance A-Facial expression

3. General appearance B- Posture, Position

3. General appearance C- Hygiene

3. General appearance D- Nutrition

3. General appearance E- Behavior • Child's personality • Level of activity • Reaction to stress Requests • Frustration • Interactions with others and response to stimuli • Is the child's calm, anxious, tense, aggressive, stable, talkative or restless

3. General appearance F- Development An overall estimate of the child's speech development, motor skills, and degree of coordination and recent area of achievement

4. Skin

4. Skin A- Color such as, red, blue, yellow or orange, are abnormal Other abnormal colors as pallor and cyanosis, erythema, ecchymosis and petechiae or jaundice

Acne

B-Temperature

C-Turgor

5. Accessory organs A- Hair

5. Accessory organs B- Nails

C- Dermatoglyphics

6. Lymph nodes

Inspect & palpate lymph nodes for size, location, temperature, tenderness, firmness & mobility

7. Head

Microcephalus Bulging anterior fontanelle Eyes deviated downward “Setting” Sun sign Hydrocephalus

8. Neck

Mumps

9. Eyes size color, symmetry, motility, inner canthus distance 3 cm. sclera, cornea, pupil, iris

Hypertelorism

Fixed and dilated pupil

Fundoscope Ophthalmoscope

10. Ears

· Hearing · Otoscope exam: pull auricle down & back for infants, toddlers, preschoolers. Pull auricle up & back for school aged & adolescents

11. Nose: location, symmetry, size, discharge, flaring nose.

12. Mouth and throat lips, gum, teeth, tongue, oral cavity, mucous membrane, palate, uvula, tonsils

Bacterial tonsillitis

13. Chest and Lung

13. Chest and Lung Inspection Chest movement Rate and depth (tachypnea, hyperpnoea) Respiratory distress

13. Chest and Lung Palpation

Respiratory expansion (excursion)

Tactile fremitus

13. Chest and Lung Percussion The examination is usually. Initiated with percussion of posterior thorax. Ideally the patient is in a sitting position with the head flexed forward and the arms crossed on the lap

13. Chest and Lung Auscultation vesicular breath sounds Broncho-vesicular breath sounds bronchial breath sounds

Abnormal breathing sounds

14. Heart Inspection Inspect heart size, note obvious bulging, apical impulse some time appear in the thin child

14. Heart Palpation Point of maximum impulse Capillary filling time

14. Heart Percussion

Auscultation

Auscultatory sites

The heart sounds are evaluated for: Quality: which should be clear and distant and not muffled or diffuse. Intensity: especially in relation to location or auscultatory site. Rate: which should be the same as the radial pulse. Rhythm: which should be regular

15. Abdomen

Abdomen The child is positioned in supine position during examination with pillow under the Head and the knee flexed to enhance abdominal relaxation. The abdomen is divided into four quadrants that correlate with underlying anatomical structures.

Umbilical Hernia

Measuring Abdominal Circumference

Palpation • • • Warm hands Distraction Light palpation Painful areas last Let child help you in palapation

16. Genitalia

Inguinal Hernia

17. Musculoskeletal system Back & extremities is concerned of the spine , legs , hands , feet , joints & muscles

A. Spine: Newborn, infant: rounded or Cshaped Toddler : S shape

B. Extremities Bowlegs normal in infant and toddler Knock knee normal in preschool

C. Joints: Joints are evaluated for range of motion , heat tenderness & swelling. D. Muscles: Symmetry and quality of muscle development , tone & strength are noted. - Development is observed by looking at the shape of the body in both a related a tense state.

18. Nervous system Assess mental status Assess sensory intactness and discrimination

Assess reflexes for the new born and infants Blinking reflex Rooting reflex (4 months) Sucking (6 months) Swallowing Sneezing and coughing Gagging Grasping (6 months) Moro/startle (4 months) Tonic neck (5 months) Dancing (4 weeks)