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Revised March, 2013

SVG COMMUNITY COLLEGE


DIVISION OF NURSING EDUCATION

PHYSCIAL ASSESSMENT

NAME: .

DATE: ..

AGE:

WARD: ..

Introductions: Place a circle around the appropriate response. Please write


comments where necessary.

GENERAL APPEARANCE

POSTURE Upright/ Bent


ODOUR Pleasant/ Unpleasant
GAIT Straight/ Unsteady
FACIAL EXPRESSION Pleasant/ Anxious / Unresponsive
GROOMING Tidy / Unkempt
MANNER Calm/ Worried/ Withdrawn
SPEECH Clear/ Stammering/ Slurred
AWARENESS Alert/ Dazed/ Unconscious

SKIN

COLOUR Normal/ Pale/ Hypo/ Hyperpimented


RASH Yes/ No
ODOUR Good/ Poor
DRYNESS Yes/ No
LESIONS Yes/ No
TEMPERATURE Cool/ Warm/ Hot
TURGOR Good/ Poor
HYGINENE Clean/ Dirty
LESIONS Scars/ Keloid/ Mascule/ Papule/ Vesicle
LOCATION

HAIR

DISTRUBUTION Good/ Poor


CLEANLINESS Yes/ No
PARASITES Yes/ No
TEXTURE Fine/ Coarse
COLOUR Black/ Brown/ Grey/ Chemically Treated

SCALP CONDITION

BRUISES Yes/ No
LUMPS Yes/ No
BLEEDING Yes/ No
TENDERNESS Yes/ No
FACE

LESIONS/ ACNE Yes/ No


RASH Yes/ No
OILNESS Yes/ No
SYMMETRICAL Yes/ No
PIGMENTATION Normal/ Hypo/ Hyper
WEAKNESS Yes/ No

EYES

GROSS VISION Yes/ No


COLOUR VISION Yes/ No
BURNING Yes/ No
CONJUNCTIVA Clear/ Red/ Pink/ Yellow
SCLERA Clear/ Yellow/ Discoloured
PAIN Yes/ No
FOREIGN BODY Yes/ No

OTHER/ COMMENTS:
.

PUPIL SIZE (DRAW)

L.R. L.R. L.R.

PUPILLARY REACTION

COMMENTS:

NOSE

SYMMETRICAL Yes/ No
FLARING Yes/ No
PATENCY Yes/ No
MUCOUS MEMBRANE Pink/ Pale
DISCHARGE Yes/ No Amount:.. Colour:
.

MOUTH

MOISTURE Yes/ No
SWALLOWING REFLEX Yes/ No
TONGUE Clean/ Coated
TEETH Clean/ Caries/ Dentures
ODOUR Pleasant/ Unpleasant
GUMS Healthy/ Unhealthy

COMENTS: .
Revised March, 2013

NECK

SWELLING Yes/ No
STIFFNESS Yes/ No
ENLARGED Yes/ No
RANGE OF MOTION Satisfactory/ Unsatisfactory

EARS

HEARING (Whisper Test) Yes/ No


REDNESS Yes/ No
DISCHARGE Yes/ No
ALIGNMENT Normal/ Low Set

THORAX/ LUNGS

BREATHING PATTERN Normal/ Rapid/ Laboured


RESPIRATORY RATE
INTERCOSTAL RETRACTION Yes/ No
SYMMETRY
HEART RATE (APICAL PULSE)

BREAST

SIZE Small/ Normal/ Large


COLOUR Normal/ Dark/ Pale
SHAPE Normal/ Void/ Pendulous
LESION Yes/ No
MASSES Yes/ No
DIMPLING Yes/ No
DISCHARGE Yes/ No
COLOUR

COMMENTS:

ABDOMEN INSPECTION

SIZE Small/ Normal/ Large


SCARS Yes/ No
SHAPE Normal. Ovoid/ Pendulous
LESIONS Yes/ No
DISTENTION Yes/ No

AUSCULTATION

BOWEL SOUNDS Normal/ Reduced/ Loud


PERCUSSION

PALPATION

TENDERNESS Yes/ No
MASSES Yes/ No
RECTUM

HEMORRHOIDS Yes/ No
RASH Yes/ No
MASSES Yes/ No

NEUROLOGICAL

PAIN Yes/ No
RESPONSE TO LIGHT Touch Good/ Poor
MUSCLE TONE Good/ Poor
MOVEMENT OF LIMBS Yes/ No
SLURRING OF SPEECH Yes/ No

MUSCULOSKELETAL

RANGE OF MOVEMENT OF SPINE Good/ Poor


ALIGNMENT OF LEGS AND FEET Yes/ No
VARICOSITIES Yes/ No
OEDEMA Yes/ No
TENDERNESS/ PAIN IN JOINTS Yes/ No
SWELLING OF JOINTS Yes/ No
MUSCLE WASTING Yes/ No

DATE: .

SIGNATURE: