Head to Toe Physical Exam

Inspect: Respirations & skin characteristics Palpate: tactile fremitus, lumps, or tenderness Percuss lung fields Auscultate breath sounds

Ask the person to lean forward & exhale briefly; auscultate cardiac base for any murmurs

Test ROM & muscle strength of hands, arms & shoulders Palpate the epitrochlear nodes

Inspect for symmetry, mobility & dimpling as the woman lifts arms over the head, pushes the hands on the hips & leans forward Inspect superclavicular & infraclavicular areas Help the woman lie supine with head at a 30- to 45- degree angle. Stand at the person's right side. Drape the gown up across shoulders & place and extra sheet across lower abdomen.

Palpate each breast, lifting the same side arm up over head. Include the tail of Spence and areola Palpate each nipple for discharge Support the person's arm and palpate axilla & regional lymph nodes Teach breast self-examination

Inspect & palpate while palpating the anterior chest wall Supporting each arm, palpate the axilla and regional nodes

Inspect each side of neck for a jugular venous pulse, turning the person's head slightly to the other side Estimate jugular venous pressure, if indicated

Inspect the precordium for any pulsations &/or heave (lift) Palpate the apical inpulse & note the location Palpate precordium for any abnormal thrill Auscultate apical rate & rhythm

Auscultate with the diaphragm of the stethoscope to study heart sounds, inching from the apex up to the base & vice versa Auscultate the heart sounds with the bell of the stethoscope, again inching through all locations Turn the person ocer to left side while again auscultating apex with the bell

Inspect: contour, symmetry, skin characteristics, umbilicus & pulsations Auscultate bowel sounds Auscultate for vascular sounds over the aorta & renal arteries Percuss all quadrants Percuss height of the liver span in tight midclavicular line

Percuss the location of the spleen Palpate: light palpation in all quadrants, then deep palpation in all quadrants Palpate for liver, spleen, kidneys & aorta Test the abdominal reflexes, if indicated

Palpate each groin for the femoral pulse & the inguinal nodes Lift the drape to expose the legs

Inspect: symmetry, skin charactristics & hair distribution Palpate pulses: poplieal,posterior tibial, dorsalis pedis Palpate for temperature & pretibial edema Separate toes & inspect Test ROM & muscle strength of hips, knees ankles & feet

Ask the person to sit up & to dangle the legs off the bed or table. Keep the gown on & the drape over the lap Note muscle strength as person sits up

Test sensation in selected areas on face, arms, hands legs & feet: superficial pain, light touch & vibration Test position sense of finger, one hand Test stereognosis Test cerebellar function of the upper extremities using finger-to-nose test or rapid-alternating-movement test