Skills #3
Percusses the spleen• An oval is of dullness
Abdomen
A. Inspection Normal Findings
1. Observe the • Paler than the general
coloration of the skin skin tone
2. Notes for the • Scattered fine veins
vascularity of the • Silver-white striae
abdominal skin and (stretch marks) or
presence of any striae surgical scars
3. Inspect for Scars • Pale smooth and
minimally raised old
scars
4. Assesses for lesions• Free of lesions or
and rashes rashes
5. Inspect the • Color: Umbilical skin
umbilicus tones
• Location: Umbilical at
the midline at lateral
line
• Contour: Inverted or
protruding not more
than 0.5 cm
• Round or conical
6. Inspects abdominal• Flat, rounded or
contour scaphoid (thin adults)
• Evenly rounded
7. Assesses for • Symmetry
abdominal symmetry • No bulge when raises
head
8. Inspect abdominal • Symmetric
movements when the movements caused by
client breathes respiration
9. Observes for aortic • (Aortic pulsation in
pulsation or peristalsis thin persons at
waves
epigastric area)
B. Auscultation Normal Findings
1. Auscultates for • Audible bowel sounds
bowel sounds
2. Auscultates for • Absence of arterial
vascular sounds bruits or venous hum
• 2. Observes and
3. Auscultates for a • Absence of friction
friction rub over the rub over liver or
liver and spleen spleen
• majora and perineum
C. Percussion • Normal Findings
1. Percusses for tone • Dullness specially over
the liver and spleen,
or a full bladder
•
2. Percuss the height of• 6 to 12 cm in the
liver to determine its midclavicular line; 4 –
size.
8 cm midsternal line.
•
3.
approximately 7 cm
wide near the left 10th
rib and posterior to
the MAL
•
4. Performs blunt • No tenderness elicited
percussion on the liver
D. Palpation • Normal findings
1. Perform light • Non tender and soft
palpation relaxed abdomen with
smooth
2. Performs deep • Consistent tension
palpation to all •
quadrants
3. Palpate for masses • No palpable masses
•
4. Palpate the umbilicus• Free from swelling,
and surrounding areas bulges or masses
for swelling, bulges or •
masses
5. Palpate the • Normal aorta 2.5 cm –
abdominal aorta 3 cm wide with
regular pulse and
moderately strong
• Possibly
6. Palpate the liver • Lower edge is felt –
firm, smooth and even
• Mild tenderness
•
7. Palpates the spleen• Not palpable at the
left costal margin
•
8. Palpates the • Not palpable
kidneys •
9. Palpates the urinary• Not palpable
bladder
Female Genitalia
External
A. Inspection Normal Findings
1. Inspects the mon (check for infestation
pubis and color)
No enlargement or
palpates inguinal swelling
lymph nodes
3. Inspects the labia Equal in size and free
of lesions and swelling
4. Inspects the labia Symmetric, dark pink n
minora, clitoris, moist. No lesions,
urethral meatus and swelling or discharges
vaginal opening
B. Palpation Normal Findings
1. Palpates Bartholin’s Soft not tender
glands
2. Palpates the urethra no discharge and
smooth
 3. Palpates the Smooth and nontender
Internal peritoneal cavity
A. Inspection Normal Findings Prostate Gland
1. Inspects the size of Varies in size 1. Palpates the Normally nontender,
the vaginal opening prostate gland by rubbery and smooth
and the angle of the turning the hand fully 2.5cm long and heart
vagina counterclockwise so shape
2. Inspects the vagina (ask the client to the pad of your index
musculature squeeze her vagina) finger faces towards
3. Inspects the cervix (normally smooth, pink the client’s umbilicus,
using a speculum and even) then move the pad of
4. Inspects the vagina No discharges and your index finger over
abnormal odor the prostate gland, to
B. Palpation Normal Findings feel the sulcus
1. Palpates the vaginal (should feel smooth between lateral lobes
wall, cervix and uterus and no tenderness)
using bimanual Musculoskeletal System
examination Gait
1. Observes the client’s Evenly distributed
Male Genitalia gait weight, Posture erect,
Scrotum arms swing in position
A. Inspection Normal Findings and able to stand on
1. Inspects the size, (varies in size, should heel and toe
shape and position be in the middle, 2. Assesses for the risk Client doesn’t fall
normally left is lower) of falling backward
2. Inspects the scrotal Thin and crinkled Temporomandibular Joint (TMJ)
skin 1. Inspects and The client’s mouth
B. Palpation Normal Findings palpates the TMJ opens and closes
1. Palpates the scrotal Equal in shape not smoothly
contents tender 2. Tests range of Jaw has full ROM
2. Transilluminate the No glow, not motion against resistance
scrotal contents transilluminated Sternoclavicular Joint
Inguinal Area 1. Inspects for location No visible bony over
A. Inspection Normal Findings in midline, color, growth
1. Inspects for inguinal, Free from bulges swelling, and masses
femoral and scrotal 2. Palpates for No swelling, pain and
hernia tenderness or pain tenderness
B. Palpation Normal Findings Cervical, Thoracic and Lumbar spine
1. Palpates for inguinal Bulging or masses are 1. Observes the Cervical and lumbar
hernia and inguinal not normally palpated cervical, thoracic and spines are concave;
nodes lumber curves from the thoracic spine is
2. Palpates inguinal Bulging or masses are side then from behind convex. Spine is
lymph nodes not normally palpated straight
3. Palpates for femoral Bulging or masses are 2. Palpates the spinous Nontender spinous
hernia not normally palpated processes and the process
4. Palpates for scrotal Bulging or masses are paravertebral muscles
hernia not normally palpated on both sides of the
Anus and Rectum spine for tenderness or
A. Inspection Normal Findings pain
1. Inspects the perianal The anal opening 3. Test ROM the Flexion and extension
area should appear hairless, cervical spine of cervical spine are 45
moist and tightly degrees
closed 4. Test ROM of the Smooth movement
2. Inspects the Normally smooth, free thoracic and lumbar and spinal processes
sacrococcygeal area from redness and hair spine are in alignment
B. Palpation Normal Findings Shoulders and Arms
1. Palpates the anus Client’s sphincter 1. Inspects and Symmetrically round,
relaxes, permitting palpates shoulders and no redness and
entry arms swelling
2. Palpates the rectum Rectal mucosa is 2. Test ROM Client has full ROM,
normally soft, smooth the clients reports no
and nontender tenderness
Elbows 2. Observes posture Relaxed, back erected
1. Inspects size, shape, Symmetric and without and body movement
deformities, redness or deformities 3. Observes dress, No body odor
swelling grooming and hygiene
2. Test ROM Client has full ROM 4. Observes facial Smiling and no sign of
against resistance expression distress
Wrists 5. Observes speech Moderate tone and
1. Inspects wrists size, Symmetric without understandable
symmetry, color and redness 6. Observes moods, Cooperative and
swelling feeling and expressions friendly
2. Palpates for No tenderness 7. Observes thoughts Verbalized positive,
tenderness and processes and healthy-thoughts
nodules perceptions
3. Test ROM Client has full ROM 8. Tests cognitive Client is aware
against resistance abilities:
Hands and Fingers a. Orientation to time,
1. Inspects size, shape, Symmetric and place and person
symmetry and color nontender
2. Palpates the fingers No nodules palpated b. Concentration Able to focus
from distal end c. Recent memory Able to recall
proximally information
3. Tests ROM Client has full ROM d. Remote memory Able to recall
against resistance memories
Hips e. Use of memory to Able to recall words
1. Inspects symmetry Hips are stable and learn new information
and shape of hips buttocks are equally in f. Abstract reasoning Can explain similarities
size and differences
2. Palpates for stability, Nontender and g. Judgement With rationalized
tenderness and without crepitus answer
crepitus h. Visual, perceptual With good perception
3. Test ROM Client has full ROM and constructional
against resistance ability
Knees
1. With the client Symmetric, no swelling Cranial Nerves
supine or sitting with and without 1. Test CN I (olfactory) by Client correctly
knees dangling, deformities asking client to clear the identifies scent
inspects for size, nose and identify a scented presented to each
shape, symmetry, object that you are holding nostril
swelling, deformities
and alignment 2. Test CN II (optic): Client has 20/20
2. Palpates for Nontender, cool and a. Uses a Snellen’s chart vision OD and OS
tenderness, warmth, no nodules
consistency and b. Ask the client to read a Client reads print
nodules newspaper or magazine at 14 inches
3. Test ROM Client has full ROM paragraph to asses near without difficulty
against resistance vision
Ankle and Feet c. Assesses visual fields by Full visual fields
1. With the client Toes and feet are in confrontation
sitting, standing and alignment, smooth, 3. Test CN III (oculomotor), Eyelids covers
walking, inspects free of corns and IV (trochlear) and VI 2mm of the Iris
positions, alignment calluses and (abducens):
shape and skin longitudinal arch a. Inspects margins of the
2. Palpates ankle and No pain, heat and eyelids of each eye
feet for tenderness, nodules noted
heat, and swelling b. Assesses extraocular Eye move in a
3. Test ROM Client has full ROM movements smooth,
against resistance coordinated
motion in all
direction
Skill #4
Mental Status and Level of Consciousness
1. Notes level of Alert and oriented
consciousness
c. Assesses for pupillary
response to light and
accommodation in both
eyes
4. Test CN V (trigeminal):
a. By motor function – asks
the client to clench the teeth bilaterally
while you palpate the
temporal and masseter
muscles for contraction
b. By sensory function –
Touches the forehead,
cheeks and chin with the
sharp or dull side of a paper
clip, then varies the sharp
and dull stimulus in the
facial areas and compares
sides
c. Tests corneal reflex
by asking the client to look
away and while you lightly
touch the cornea with a fine
wisp of cotton
5. Tests CN VII (facial):
a. By motor function – ask
the client to smile, frown,
wrinkle forehead, show
teeth, puff out cheeks, purse
lips, raise eyebrows and
close eyes tightly against
resistance
b. By sensory function –
touch the anterior two-
thirds of the tongue with
moistened applicator dipped
in salt, sugar (sweet) and
lemon juice (sour) and ask
the client to identify the
taste
6. Tests CN VIII
(acoustic/vestibulocochlear)
a. Tests the client’s hearing
ability in each ear by
whispering words from 1 to
2 feet
b. Performs Weber’s test
c. Performs Rinnes’ test
d. Performs Heel to toe
walking
b. Performs Romberg test
7. Tests CN IX
(glossopharyngeal)
And X (vagus):
Bilateral a. By motor function – asks symmetrically on
illuminated pupils the client to open mouth phonation
constrict wide and say “ah” while
simultaneously using a tongue depressor
b. Test the gag reflex Gag reflex intact
Temporal and
masseter contract c. Assesses the ability to Swallows without
swallow difficulty
d. By sensory function (CN Clients identifies
IX) - touch the posterior of correct flavor
the tongue with moistened
applicator dipped in salt,
sugar (sweet) and lemon
Client correctly juice (sour) and ask the
identifies sharp, client to identify the taste
dull and light 8. Tests the CN XI (spinal There is
touch accessory) by asking the symmetric, strong
client to shrug the shoulders contraction of the
and turn the head against trapezius muscle
resistance
8. Tests the CN XII Tongue
Eye blinks laterally (hypoglossal) by asking the movement is
client to protrude tongue, symmetric and
move it to each side against smooth bilateral
the resistance of a tongue strength is
depressor, then withdraw apparent
tongue back in the mouth
Movements are
symmetrical
Deep tendon test
1. Tests Biceps reflex by Normal reflex
asking the client to partially scores range from
bend arm at elbow with 1+ (present but
palm up, then place your decreases) 2+
Clients identifies thumb over the biceps (normal) to 3+
correct flavor tendon and strike your (increased but not
thumb with reflex hammer. pathologic)
Repeats the other side
2. Tests Brachioradialis Normal reflex
reflex by asking the client to scores range from
flex elbow with palm down 1+ (present but
and resting on the abdomen decreases) 2+
Client hear or lap, then tap the tendon (normal) to 3+
whispered words at the radius about 2 inches (increased but not
from 1-2 feet above the wrist. Repeats the pathologic)
other side
3. Tests Triceps reflex by Normal reflex
asking the client to hang his scores range from
negative result of or her arm free while you 1+ (present but
Weber test support it with your decreases) 2+
positive results in nondominant hand, then (normal) to 3+
Rinnes test with the elbow flexed, tap (increased but not
the tendon above the pathologic)
Able to walk in
olecron process. Repeats the
heel and toes
other side
With good 4. Tests Patellar reflex by Normal reflex
balance asking the client to let both scores range from
Uvula and soft legs hang freely of the side 1+ (present but
palate rise of the examination table, decreases) 2+
bilaterally and then tap the patellar (normal) to 3+
tendon, which is located just (increased but not
below the patella. Repeats pathologic)
the other side
5. Tests Achilles reflex when Normal reflex
the client’s legs hang freely, scores range from
dorsiflex the foot, then tap 1+ (present but
the Achilles tendon with decreases) 2+
reflex hammer. Repeats the (normal) to 3+
other side (increased but not
pathologic)