1. Integration of the Physical Assessment Putting it all together Dr. Sara Mitchell November 3, 2006

2. At the very beginning Introduce yourself and explain what you are about to do Take the client's history Take measurements vital signs/ height & weight

3. Helpful Hints Be prepared gather supplies & equipment before starting examination test all equipment to make sure it is in working order Be organized and systematic in your approach use the fewest number of client position changes

4. Preparation for examination Equipment needed Client and environment readiness

5. Techniques for examination Inspect general appearance skin color consistency of general appearance with age general state of nutrition hygiene obvious physical deformities, limitations, use of assistive devices

6. Techniques for examination Inspect stature and movement symmetry posture body build mobility

7. Techniques for examination Inspect demeanor facial expression composure speech orientation and mental status disposition eye contact

8. With the client sitting and the examiner facing the client examine the following systems Upper extremities HEENT including face & neck Cranial nerves Spine Lungs (anterior, posterior, & lateral) Heart Breast

9. Have the client lie in a supine position with the examiner at the client’s right side examine the following: Breasts Heart Abdomen Lower extremities

10. Have the client resume a sitting position with the examiner standing in front of the client and assess the following: Neural system deep tendon reflexes (DTR’s) cerebellar function sensory function two-point discrimination stereognosis, graphesthia position sense

11. With the client still seated complete the following Assessment of upper extremities strength range of motion sensation vibration position sense

12. With the client in the standing position assess the following Examination of spine and sacral area The remainder of the neural system evaluation inspect gait assess proprioception and cerebellar function

13. Genitalia Examination For the male client the following are assessed with the client in a standing position external genitalia presence of hernia rectal exam For the female client the exam is done with the client in the lithotomy position

14. Documentation Be specific Be concise Be complete Avoid using vague terms, such as “negative”, “normal”, or “good” Be truthful only record your actual findings specify portion of the examination that were omitted or deferred