General Physical Examination

Procedure:

• Observe general rules of nursing procedures.

• Observe general appearance – posture, gait, movement, hygiene.
  Rationale: To identify obvious changes.

Inspection

• Inspect the patient’s general condition.

• Observe the patient’s ability to respond to verbal commands.
  Rationale: Indicates speech and cognitive function.

• Observe the patient’s level of consciousness and orientation.
  Rationale: Indicates brain function.

• Observe the patient’s ability to think, remember, process information, and communicate.
  Rationale: Indicates cognitive functioning.

• Note articulation of speech, including style and content.

• Observe the patient’s ability to see, hear, smell, and distinguish tactile sensations.
  Rationale: Aids diagnosis and treatment.

• Observe facial expressions and mood.

• Observe movement. (Refer to detailed weight and height measurement procedure.)

Height

• Request the patient to remove shoes and stand straight with heels and back touching the wall. Measure height.
  Rationale: Aids diagnosis and treatment.

• Use a height scale to record height.

Weight

• Weigh the patient without shoes and heavy clothing.
  Rationale: Ensures accurate measurement for diagnosis and treatment.

Inspect and palpate the skin

Assess skin, hair, nails, and overall integumentary health.
Rationale: Aids diagnosis and treatment.

• Examine the skin for appearance, texture, sensation, lesions, growths, or trauma.

• Check capillary refill by pressing the nail bed and noting the return of color.
  Rationale: Helps rule out anemia.

Head

• Inspect the hair for color, texture, growth, and distribution.
  Rationale: Detects abnormalities.
• Observe the size, shape, and symmetry of the head.
• Palpate the head for deformities, depressions, or tenderness.

Face

• Inspect facial expression, asymmetry, involuntary movements, edema, and masses.
  Rationale: To rule out paralysis or facial issues.

Eye

• Inspect both eyes for position, alignment, symmetry, and color.
  Rationale: Detects abnormalities.

Nose

• Inspect the nose’s anterior and inferior surfaces. Gently press the tip of the nose to examine nostrils.
• Use a penlight to view nasal vestibules. Observe for symmetry, size, flaring, and sensation.
  Rationale: Detects abnormalities.

Mouth

• Observe lips, mucous membranes, gums, tongue, teeth, and palate for color, moisture, texture, and sensation.
  Rationale: Detects abnormalities.

Neck

• Inspect and palpate the ears for shape, size, symmetry, and patency using an otoscope.
  Rationale: Detects abnormalities.

• Inspect and palpate lymph nodes using the pads of your index and middle fingers. Assess for location, size, shape, texture, and pain.
  Includes: Preauricular, postauricular, occipital, tonsillar, submandibular, submental, superficial and posterior cervical, deep cervical chain, supraclavicular nodes.
  Rationale: Helps detect infection or other conditions.

• Inspect and palpate the jugular vein.
  Rationale: To rule out distention of jugular veins.

Inspect the thyroid gland

• Ask the patient to extend the neck and swallow. Observe movement, contour, and symmetry.
  Rationale: To detect abnormalities.

Palpate the thyroid gland 

• stand on the patient’s right side. Ask them to lean slightly forward and swallow while you feel for the gland.
  Rationale: Relaxes the sternomastoid and helps assess for enlargement.

Chest,Lung and heart

• Ask the patient to sit on the side of the bed and expose the chest. Observe chest movement and symmetry.
  Auscultate the lungs and heart.

Breast and Axilla

• Inspect the breasts for appearance, color, symmetry, size, shape, and texture.

Nipple

• Inspect the nipples for symmetry, shape, scaling, fissures, ulceration, bleeding, or discharge.

• Refer to detailed procedure for breast examination.

• Expose the abdomen. Ensure hands and stethoscope are warm.
  Rationale: To avoid muscle tension and discomfort.

• Position the patient supine. Inquire about painful areas and examine these last.
  Rationale: Prevents muscle guarding.

Inspect the abdomen

• Observe color, shape, symmetry, and any visible pulsations or bulging.
  Rationale: Detects abnormalities such as masses or aneurysms.

• Auscultate bowel sounds before percussion and palpation.
  Use the diaphragm to listen to bowel sounds; if absent, listen for 5 minutes. Use the bell to listen for vascular sounds.
  Rationale: Prevents alteration of bowel activity; bruit suggests aneurysm.

• Percuss the abdomen to assess tone.
  Rationale: Identifies gas, fluid, or masses.

• Perform light palpation – depress about 1cm with a rotary motion, moving clockwise across the abdomen.
  Rationale: Detects tenderness or superficial masses.

• Perform deep palpation – use fingertips or bimanual technique for obese patients.
  Palpate for kidneys, liver, spleen, and femoral pulse.
  Rationale: Detects enlargement, abnormalities, or masses.

• Ask the patient to stand. Inspect the neck, shoulders, arms, hands, hips, knees, legs, ankles, and feet. Compare both sides.
  Rationale: To detect swelling, deformities, or masses.

• Palpate each joint for tenderness, swelling, or crepitus.
  Ask the patient to move joints to assess range of motion.
  Rationale: Assesses joint integrity and function.