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Competency Checklist - Physical Assessment, Exercises of Nursing

Ateneo de Manila University (ADMU)Nursing

This document is a competency checklist to verify your skills to perform physical assessments on a patient. It is a guide or a checklist that can benefit both students and professors in evaluating their skills.

Typology: Exercises

2021/2022

Available from 12/22/2022

GrowYourSideHustles
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Name: _____________________________________________________Date: ________________
Course: _______________________________________ ____ Grade:_______________
PHYSICAL ASSESSMENT
PROCEDURES Done Not
Done
Comments
1. Wash hands with soap or hand sanitizer
before starting examination.
2. Explain procedure to the patient.
3. Provide privacy.
I. HEAD AND SINUSES
1. Inspect the skull for its general size, shape and
contours.
2. Note the hair texture and quantity.
3. Examine the scalp for skin lesions. Have
patient bend her head slightly forward. Inspect
the skin by parting the hair in several places with
your fingers.
4. Note scaliness, lumps, or other skin lesions.
5. Palpate the scalp. Use the palmar aspects of
the fingertips. Feel front to back with short
sweeping motions. Note lumps or tender areas.
A. Frontal Sinus
1. Palpate or percuss for tenderness above each
eye.
B. Maxillary Sinus
1. Palpate or percuss for tenderness below each
eye.
2. Must ask patient about pain or tenderness.
C. LYMPH NODES AND THYROID
1. Preauricular nodes bilaterally - palpate in front
of ears.
2. Posterior auricular nodes bilaterally - palpate
behind ears.
3. Occipital nodes bilaterally - palpate at the base
of the skull.
4. Anterior cervical nodes bilaterally - palpate
anterior to and over the sternocleidomastoid
muscle throughout its whole length.
5. Posterior cervical nodes bilaterally - palpate
posterior to and under the sternocleidomastoid
muscle throughout its whole length.
6. Tonsillar lymph nodes bilaterally - palpate at
angle of jaw.
7. Submental lymph nodes bilaterally - palpate
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Partial preview of the text

Download Competency Checklist - Physical Assessment and more Exercises Nursing in PDF only on Docsity!

Name: _____________________________________________________Date: ________________ Course: _______________________________________ ____ Grade:_______________ PHYSICAL ASSESSMENT PROCEDURES Done Not Done Comments

  1. Wash hands with soap or hand sanitizer before starting examination.
  2. Explain procedure to the patient.
  3. Provide privacy. I. HEAD AND SINUSES
  4. Inspect the skull for its general size, shape and contours.
  5. Note the hair texture and quantity.
  6. Examine the scalp for skin lesions. Have patient bend her head slightly forward. Inspect the skin by parting the hair in several places with your fingers.
  7. Note scaliness, lumps, or other skin lesions.
  8. Palpate the scalp. Use the palmar aspects of the fingertips. Feel front to back with short sweeping motions. Note lumps or tender areas. A. Frontal Sinus
  9. Palpate or percuss for tenderness above each eye. B. Maxillary Sinus
  10. Palpate or percuss for tenderness below each eye.
  11. Must ask patient about pain or tenderness. C. LYMPH NODES AND THYROID
  12. Preauricular nodes bilaterally - palpate in front of ears.
  13. Posterior auricular nodes bilaterally - palpate behind ears.
  14. Occipital nodes bilaterally - palpate at the base of the skull.
  15. Anterior cervical nodes bilaterally - palpate anterior to and over the sternocleidomastoid muscle throughout its whole length.
  16. Posterior cervical nodes bilaterally - palpate posterior to and under the sternocleidomastoid muscle throughout its whole length.
  17. Tonsillar lymph nodes bilaterally - palpate at angle of jaw.
  18. Submental lymph nodes bilaterally - palpate

directly under the chin.

  1. Submandibular lymph nodes bilaterally - palpate between tonsillar and submental nodes.
  2. Thyroid gland - palpate first without swallowing and then with swallowing.
  3. Stands behind patient. However, this may be done while standing in front of the patient, as well. Be prepared to offer the patient a cup of water in case the patient is having difficulty swallowing. D. EYES
  4. Test visual acuity bilaterally and separately with a pocket visual screening chart by holding the chart 14" from patient’s face. It is acceptable for patient to hold the card herself. If patient wears glasses, patient should be allowed to keep them on during this exam.
  5. Test visual fields bilaterally (four quadrants for each eye by confrontation, each eye separately). Make sure your fingers are outside of the patient’s field of vision before you begin this test. Check with the patient as you test each quadrant to be sure that your fingers cannot be seen at the onset.
  6. Check for convergence by holding your finger in front of patient’s face and moving your finger in towards patient’s nose. You should start at arm’s length and go about 5-8 centimeters from nose.
  7. Test cranial nerves III, IV, and VI by asking patient to hold her head completely still and follow only your finger, looking rightward and leftward, up and out, up and in, down and out, and down and in to the extremes of gaze.
  8. Test cranial nerve VII motor function by asking patient to close her eyes as student tries to force the eyelids open (upper division).
  9. Observe pupillary responses bilaterally: Note: The Direct Response is tested as you shine penlight into patient’s eye. You will first look into that eye for a direct response to the light. Remove light from eye and let pupil return to normal. Then shine penlight in that same eye, while observing pupil of the opposite eye. The Indirect Response to light (consensual) is tested by looking into the eye not exposed to the direct light.
  1. Test cranial nerve VII (lower division) motor function by asking patient to show the teeth. II. LUNGS AND THORAX Note: All percussion and auscultation must be done on skin with fingers. All auscultation must include full inhalation and exhalation.
  2. Inspect thorax/chest.
  3. Palpate for tactile fremitus.
  4. Percuss the posterior lung fields bilaterally and symmetrically, over the upper, middle and lower lung fields, comparing the left side and the right side at each of the three levels.
  5. Auscultate the posterior lung fields bilaterally and symmetrically, comparing right and left - three levels. Instruct patient to breathe through an open mouth before auscultation.
  6. Percuss the anterior lung fields (at least one level) on the upper chest, bilaterally and symmetrically.
  7. Auscultate the anterior lung fields (upper lobes), bilaterally and symmetrically. Before auscultating, instruct patient to breathe deeply through an open mouth.
  8. Auscultate the lateral lung fields (right middle lobe and lingula) bilaterally and symmetrically. Before auscultation, instruct patient to breathe deeply through an open mouth. III. BREAST EXAM PART 1
  9. With the patient in the sitting position, ask patient to lower the gown so that both breasts are visible. Inspect the appearance of the skin, size and dimpling of the breasts, and contour of the breasts.
  10. Instruct patient to raise arms outstretched above the head and examine each breast for dimpling, contour changes, and skin discoloration.
  11. Instruct patient to hold hands against hips, press inward, and instruct patient to lean forward. Inspect again for dimpling.
  12. Palpate the axillary nodes in the following four

areas:

  1. anterior axillary fold;
  2. posterior axillary fold;
  3. along the proximal humerus; and
  4. deep in the axillary vault. (This should be done with patient’s arm relaxed.) IV. BREAST EXAM PART 2
  1. Instruct patient to lie down supine. Instruct patient to raise the ipsilateral arm above her head.
  2. Use the middle three digits of your dominant hand to palpate the breast starting at the top of the breast on the side of the sternum. Repeat on the opposite breast.
  3. Use 3 types of pressure while palpating, starting with a light pressure, then a medium pressure, then a firm pressure on each area covered. Fingers must never lose contact with the skin of the breast.
  4. The “strip” technique - with your fingers never losing contact with the breast, descend from top to bottom and bottom to top in vertical lines until all regions (including the nipple as part of the breast tissue) have been palpated. V. HEART Note: All palpation and auscultation must be done on skin.
  5. Elevate the trunk, head and neck 30 – 45 degrees so that the jugular venous pulse is visible. If no jugular venous pulse is visible, place the exam table in the flat position and check again for a visible right jugular vein. (Only one pulse on one side of the neck needs to be examined.)
  6. Note: For cardiac palpation, patient should be supine, with exam table flat or elevated to 30- degrees. a. Regarding the term “palpation” when used during the cardiac examination: This palpation is designed to assess for pulses, thrills, etc. You are not feeling for masses. Therefore, your fingers should not move in a circular motion but rather should remain motionless in the appropriate anatomical location.
  7. Palpate the aortic area (2nd intercostal space on the right), using only the pads of the fingers, not the fingertips.
  1. Palpate the dorsalis pedis pulses bilaterally (located on top of foot, midway between the toes and the ankle, along the tendon line). These can be assessed simultaneously.
  2. Test for peripheral edema: Check each shin for pitting edema by pressing on the lower anterior tibia, medial malleolus, or dorsum of foot for approximately 3 seconds. Must examine both legs. Must be done on skin. VI. ABDOMEN
  3. Adjust the examination table to be flat. Position patient in supine position. Stand on the patient’s right side. All auscultation, percussion and palpation must be done on skin.
  4. Inspect abdomen. Expose (uncover) abdomen to its full boundaries.
  5. Auscultate each of the four quadrants of the abdomen.
  6. Percuss each of the four quadrants of the abdomen.
  7. Percuss the liver span from just below right nipple line to just below right rib cage, listening for the sound to change.
  8. Palpate the liver edge. Place your hand in the proper location. Ask patient to inhale as you attempt to push up and under right rib cage. Then, ask patient to exhale and continue to push up and under liver edge, without causing pain to patient.
  9. Palpate the spleen. a. With your left hand, reach over and around the patient to support and press forward the lower left rib cage. b. With your right hand below the costal margin, press in towards the spleen and ask patient to take a deep breath as you push up and in, at the bottom of the left rib cage. This can be done either supine or with the patient lying on her right side.
  10. Palpate the left upper quadrant using two pressures (gently then firmly).
  11. Palpate the right upper quadrant using two pressures (gently then firmly).
  12. Palpate the right lower quadrant using two pressures (gently then firmly).
  1. Palpate the left lower quadrant using two pressures (gently then firmly). VII. MUSCULOSKELETAL
  2. Inspect and palpate both hands (palm and dorsum).
  3. Assess finger extension by asking patient to spread the fingers of both hands.
  4. Assess finger flexion by asking patient to make a fist with both hands.
  5. Screen range of motion for both wrists. May be done actively or passively. a. Have patient flex and extend each wrist while you observe. b. Observe radial and ulnar deviation (medial and lateral wrist movement)
  6. Inspect and palpate both wrists for redness and swelling.
  7. Screen range of motion of both elbows. May be done actively or passively. a. Instruct the patient to extend her arms in pronation and then supination. Observe movement of elbow. b. Have patient flex and extend each elbow. Observe movement of elbow.
  8. Inspect and palpate both elbows. Inspect the olecranon areas for bursal or joint swelling, and over the ulnar ridge for nodules.
  9. Inspect and palpate both shoulders. Note any swelling, deformity, atrophy, fasciculation or abnormal positioning. Palpate the top of the shoulder at the acromioclavicular (AC) joint, lateral shoulder over the greater tubercle of the humerus and anterior shoulder over the coracoid process. Standing behind patient while assessing shoulder movements is important for you to observe symmetry.
  10. Shoulder flexion: Stand behind patient and have patient’s gown completely untied and open in the back. Observe shoulder flexion by asking patient to bring the arms forward and then raise them overhead.
  11. Shoulder internal rotation: Stand behind patient and have patient’s gown completely untied and open in the back. Instruct the patient to place both hands behind the back as high up
  1. Inspect the plantar surface of both feet.
  2. ASK PATIENT TO STAND a. Observe the alignment of the knees, heels and feet: Patient must stand. b. Position yourself behind patient. Carefully observe the alignment of the patient’s knees, heels and feet.
  3. Assess thoraco-lumbar lateral bending by asking patient to bend torso to the right and to the left.
  4. Assess lumbar flexion by asking patient to bend forward at the waist and to attempt to touch the toes.
  5. Assess lumbar extension by asking patient to bend backwards. VIII. NEUROLOGICAL
  6. Romberg Test: a. Instruct patient to stand with her arms down at her sides and with her feet completely together with eyes open. Watch for obvious unsteadiness. If she remains steady, continue with the test. b. Ask her to close her eyes and then reassure the patient that you will not let her fall. Stand close; ready to stabilize her if she begins to fall. c. Observe the patient for signs of swaying for at least 15 seconds.
  7. Ask patient to walk away from you while you observe the gait.
  8. Ask patient to walk towards or away from you on her toes and observe.
  9. Ask patient to walk towards or away from you on heels and observe.
  10. Ask patient to walk heel-to-toe (tandem gait) and observe.
  11. Pronator Drift Test: a. Ask patient to close her eyes and hold arms out in front of her, palms up. b. Observe for at least 15 seconds for signs of one of the arms dropping below the other.

The test is conducted for a full 15 seconds.

  1. Test patient’s grip strength bilaterally by asking patient to squeeze your index finger as you try to pull it out of patient’s grip.
  2. Test the deltoid muscle strength bilaterally by pushing downward on the patient’s abducted arms.
  3. Test the biceps muscle strength bilaterally, separately, and symmetrically by positioning patient’s elbow to a 90-degree bend, palm up. Then brace one palm on the biceps, grasp the wrist and pull.
  4. Test the hip flexor muscle strength bilaterally, separately, and symmetrically by having patient either seated on table with legs dangling, or supine. Resist flexion by having patient raise each knee or leg as you push down on thigh.
  5. Test the lower leg muscle strength bilaterally, separately, and symmetrically by asking the patient to push away your hand (placed on the ankle); then ask patient to pull towards herself. Position the knee to a 90 degree bend. Resist flexion by pulling up on lower leg. Resist extension by pushing down on lower leg.
  6. Test finger-to-nose coordination bilaterally. Student should move her finger several times, in different directions, so patient must accurately alter directions.
  7. Test both sharp and dull on hand or a finger bilaterally. Instruct patient to close her eyes prior to test.
  8. Test both sharp and dull on foot or a toe bilaterally with patient’s eyes still closed. Performer’s Signature Over Printed Name Instructor’s Signature