King Saud University
College of Nursing
Health Assessment (NUR 224)
General Survey & Health History
Part 2
1
Learning objectives
At the end of this module, the learner should be
able to:
1. Define the Key terms.
2. Understand the concept of physical
examination in terms of its requirements.
3. Discuss the concept of general survey in terms
of its purpose, skills, and components.
4. Discuss the four basic physical examination
techniques.
5. Identify commonly needed physical
examination equipments and their functions.
Physical Examination

Physical examination is a systematic approach
of collecting objective data about clients’
health status.

It employs through detailed evaluation of
clients’ all body structures, organs, or systems.

It requires the nurse to apply special
techniques, use equipments and knowledge
base, to physically expose each region of
clients’ body and examine it by looking,
listening, touching, or smelling.
Purpose of physical Examination
 Physical
examination is performed in all
health care settings, covering healthy
and sick clients.

It serves for screening, detection, and
prevention of disease.
 It
also provides an opportunity for health
promotion (education & counseling) as
well as the evaluation of disease process
or treatment results.
Component of Physical Examination:

General survey (the nurses’ initial observation
for the clients’ general appearance and
behavior).

Vital signs measurement

Height and weight measurement

Body systems examination
1- Physical Appearance
Normal Range of Findings
Abnormal Findings
1- Age – the person appears his or her
stated age.
Appears older, smaller, or younger, as with
chronic disease or retardation.
2- Sex – Sexual development is
appropriate for gender and age
Delayed or early puberty, or inappropriate to
gender.
3- Level of consciousness – the person is
alert and oriented, attends to your
questions and responds appropriately.
Alert. Follow commands and responds
completely and appropriately to stimuli
Lethargic. The patient is sleepy or drowsy
and will awaken and respond appropriately
to command .
Stupor. require vigorous stimulation for a
response .
Semi coma. The patient is not awake but
will respond purposefully to deep pain
Coma. The patient is completely
unresponsive.
1- Physical Appearance
Normal Range of Findings
Abnormal Findings
4- Skin color – color tone is even, skin
is intact with no obvious lesions
• Pallor, (loss of color)
• cyanosis, (bluish discoloration)
• jaundice Yellowish discoloration)
• lesions.
5- Facial features – symmetric with
movement.
6- No signs of acute distress are
present
• Immobile, masklike, asymmetric,
drooping.
• shortness of breath, wheezing.
• facial grimace, holding body part.
(Pain)
II- Body STRUCTURE
1- Stature – the height
appears within normal
range for age.
• Excessively short or tall
2- Nutritional status – the
• Underweight
weight appears within normal • Obese
range for height and body
build.
II- Body STRUCTURE
3- Symmetry – body parts look equal bilaterally
•
•
Unilateral atrophy
hypertrophy (enlargement of muscles.)
4- Posture – the person stands comfortably
erect as appropriate for age.
•
Rigid spine and neck (moves as one
unit) e.g., arthritis. Stiff and tense.
5- Position – the person sits
comfortably in a chair or on
the bed or examination table,
arms relaxed at sides, head
turned to examiner.
• Leaning forward with arms
braced on chair arms (chronic
pulmonary disease).
• Sitting straight up and resists
lying down, (left-sided
congestive heart failure).
7Physical
deformities–
Absence of any congenital or Presence of deformities or
congenital defect
acquired defects.
III- Mobility
1-Gait: the walk is smooth, even,
and well-balanced; and
Limping with injury.
associated movements,
Difficulty stopping
(symmetric arm swing), are
present.
2-Range of motion – the person Limited joint range of motion.
Paralysis – absent movement.
has full mobility for each joint.
3- Involuntary movement:
absent
Movement jerky,
uncoordinated
Tics, tremors, seizers
IV- Behavior
1- Facial expression – the
person maintains eye contact
expressions are appropriate to
the situation.
Flat, depressed, angry, sad
anxious. However, note that
anxiety is common in ill
people.
2- Mood and affect – the
person is comfortable and
cooperative with the
examiner and interacts
pleasantly.
Hostile, distrustful,
suspicious, crying
Vital
signs are the key physiologic measures of the person’s
general health state. The nurse obtains vital signs to:
a.
Establish baseline measurement.
b.
Identify physiologic problems.
c.
Monitor clients’ response to therapy.
Signs
Pulse
range
rate
Respiratory
Blood
60 - 100 beats/min
rate
pressure
Temperature
Pain
12 - 20 breath/min
100/70 to 140/90 mmHg
36.5 - 37.5 C
3- Measuring Height and weight
 Body mass index
_Weight_(kg)____
(Height) 2
 Where

Weight is measured in kilograms.

Height is measured in meters
 BODY MASS INDEX
FINDING

< 20
PERSON IS UNDER WEIGHT

=20-25
PERSON IS NORMAL WEIGHT


=25-30
PERSON IS OVERWEIGHT
>30
PERSON IS OBESE
EXAMPLE: Calculate body mass index of person, his
weight is 98kg, his height is172 cm .
 Answer steps:
 Transfer height from cm to meter
=172/100=1.72m
 Body mass index (BMI) =
98/(1.72)2
=33

BMI = 33
SO the person is obese.
4- Body systems examination
Body systems examination is the systematic
objective evaluation of client’s body structures,
parts, and organs, using the examiners’ sense
Review client health history
 Prepare equipment
 Examine client in a warm & quiet room
 Examine client in well- lighted room
 Consider patients’ privacy and comfort
 Practice and adhere to standard precaution of Infection
control
 Explain procedure to client & reassure client along the
examination. Begin examination with the patient in
sitting position( if possible). This facilitates front and
back examination
 Use appropriate Draping, such that only body part being
examined is exposed

Physical examination equipments:
Ophthalmoscope
Otoscope
Tuning fork 
Nasal speculum 
Percussion hammer 
Snellen 
chart
Basic Physical examination techniques
Physical examination utilizes four techniques
Inspection
Palpation
Percussion
Auscultation
1. Inspection

means Observing the client in a close, focused manner
using vision, and smell senses.
*It begins during the first contact with client and
continues throughout the assessment
*It provides information about body parts’: color, size,
location, movement, texture, symmetry, odor, and
sound
2. Palpation

Palpation is the use of hands and fingers to
feel different body parts for data collection.

The nurse uses pads of the fingers and palms
to touch and feel the patient’s body parts
with his hands to examine:
size texture
location
tenderness
body temperature
lumps or masses
Types of palpation
1.
Light palpation

Using the flat part of the right hand or the
pads of the fingers, not the fingertips

The fingers should be together

Depress the skin 1 to 2 cm with your finger
pads, usually the lightest touch possible.
Light palpation
2. Deep palpation

Used to determine organ size as well as the presence
of abdominal masses

The flat portion of the right hand is placed on the
abdomen

Depress the skin 4 to 5 cm with firm, deep pressure.
Pressure should be applied to the abdomen gently but
steadily

The patient should be instructed to breathe quietly
through the mouth and to keep arms at the sides
3. Percussion
 A methods of “ striking” of body parts
during physical examination with fingers to
evaluate the size, consistency, borders and
presence of fluid in body organs
 Percussion of a body part produces a sound
that indicates the type of tissue within the
organ
 It is particularly important in examining
the chest and abdomen
Methods of Percussion
1. Direct percussion:
 Using one or two fingers, tap directly on the
body part. Ask the patient to tell you which
areas are painful and watch his/her face for
signs of discomfort.
 Direct percussion is commonly used to assess
an adult patient's sinuses for tenderness.
2. Indirect Percussion

Press the distal part of the middle finger (pleximeter) of your
nondominant hand firmly on the body part(left hand).



Keep the rest of your hand off the body surface.
Flex the wrist of your dominant hand.
Using the middle finger (plexor or striking finger) of your
dominant hand, tap quickly and directly over the point where
your other middle finger touches the patient's skin. The
motion of the striking finger should come from the wrist and
not from the elbow

Deliver 2 - 3 quick taps and listen carefully.
Types of sounds
Sound
Quality of
sound
Where it is
heard
Source
Tympany
Drumlike sound
Over enclosed
air
Puffed-out
cheek, air in
bowel
Resonance
Hollow sound
Over areas of
Normal lung
part air and solid
Hyper
resonance
Booming sound
Over air
(child’s lungs) N
(adult) Lung with
emphysema
Dullness
Thudlike sound
Over solid area
Liver, spleen
Flatness
Flat sound
Over dense
tissue
Thigh Muscle,
bone, over
tumor
4. Auscultation

A method used to “listen” to the body sounds.

Various body systems like heart, lungs, and
abdominal organs have characterized sounds

Bowel, breath, heart, and blood movement
sound are heard using a stethoscope

It is important to know the normal sound to
distinguish from abnormal sound
Types of auscultation
1.
Direct auscultation:
* Uses the ear alone to listen, such as when
listening to the grating of a moving joint.
* Sounds are audible without stethoscope
2.
Indirect auscultation:
sounds are audible with stethoscope
3.
Bell for low pitched sound and diaphragm
for high pitched sound
Question?
31