physical examination abdomen, musculoskeletal and neurological system

PHYSICAL EXAMINATION

THE ABDOMEN

TechniquesInspection Palpation PercussionAuscultation

EquipmentsExamining lightStethoscopeTape measureWater soluble skin marking pencil

Four abdominal quadrants

Nine abdominal regions

Abdomen

• Inspect the abdomen for – skin integrity

– Contour and symmetry and measure the abdominal girth

– Observe abdominal movements

– Observe vascular pattern

• Auscultate the abdomen for– Bowel sounds

– Vascular sounds

– Peritoneal friction rub

Auscultation of the abdomen

Abdomen

• Percussion of the abdomen

– Use indirect percussion

– Start from the RLQ

– Normally there is generalized tympany over the bowels.

• Percuss the liver to determine its size.

– 6-12 cm in the midclavicularline

Abdomen

• Palpation of the abdomen

– Perform light palpation to detect areas of tenderness.

– Perform deep palpation to asses masses and underlying structures

• Palpate the liver to detect enlargement and tenderness

• Palpation of the bladder

THE MUSCULOSKELETAL SYSTEM

•Muscles•Bones and•Joints

MUSCLES• Inspect the muscle for

– Size

– Contractures

– Tremors

• Palpate for muscles at rest to determine muscle tonicity

• Palpate muscles while the client is active for– Flaccidity

– Spasticity and smoothness of movements

• Test muscle strength (compare the right side with the left side)

Grading of muscle strength

Bones and jointsBONES

• Inspect the skeleton for structure

• Palpate the bones to locate any areas of edema or tenderness

JOINTS Inspect the joint for swelling

Palpate each joint for tenderness, smoothness of movement, swelling, crepitation and nodules

Assess joint Range of motion

THE NEUROLOGIC

SYSTEM

The neurological system

• Mental status– Language

– Orientation (time, place and person)

– Memory (immediate, recent and remote memory)

– Attention span and calculation

• Level of consciousness (GCS scale )

• Cranial nerves

• Reflexes

• Motor and sensory function

Cranial nerves

I. Olfactory nerve

II. Optic nerve

III. Oculomotor nerve

IV. Trochlear nerve

V. Trigeminal nerve

VI. Abducens nerve

VII. Facial nerve

VIII.Vestibulocochlear nerve

IX. Glossopharyngeal nerve

X. Vagus nerve

XI. Accessory nerve

XII. Hypoglossal nerve

Cranial nerves

REFLEXES

Reflexes Spinal cord level

Biceps reflex C5C6

Triceps reflex C7C8

Brachioradialis reflex C5C6

Pattellar reflex L2 L3 L4

Achillis reflex S1s 2

Plantar reflex Superficial reflex

REFLEXES

Biceps Triceps Brachioradialis

Pattellar Achillis Babinski

Motor function

• Walking gait

• Romberg test

• Standing on one foot with eye closed

• Heel toe walking

• Toe or heel walking

• Finger to nose test

• Alternating supination and pronation of hands on knees

• Finger to nose to the nurse’s finger

• Finger to fingers

Motor function

• Finger to thumb (same hand)

• Heel down opposite shin

• Toe or ball of foot to the nurse’s finger

• Light touch sensation

• Pain sensation

• Temperature sensation

• Position or kinesthetic sensation

• Tactile discrimination

• Extinction phenomenon

Genital and inguinal area

• Male

– Inspect the distribution ,amount and characteristics of pubic hair

– Penis :

• Inspect the penile shaft & glands penis for lesions , nodules swelling and inflammation

• Inspect the urethral meatus for swelling ,inflammation and discharge

• Palpate the penis for tenderness ,thickening and nodules

• Male– Scrotum:

• Inspect scrotum for appearance ,general size, and symmetry

• Palpate the scrotum to assess status of underlying testes, epidydimisand spermatic cord.

– Inguinal area:

• Inspect both inguinal area for bulges

Genital and inguinal area

Genital and inguinal area

• Female

– Inspect the distribution , amount and characteristics of pubic hair

– Insects parasites, inflammation, swelling and lesions .

– Inspect clitoris

– Palpate the inguinal lymph nodes

THE RECTUM AND ANUS

TechniquesInspection Palpation Digital examination

PositionsLithotomyLeft sims lithotomyDorsal recumbent

The rectum and anus

• Inspect the anus and surrounding tissue for color ,integrity and skin lesions.

• Palpate the rectum for anal sphincter tonicity ,nodules, masses and tenderness