HEALTH ASSESSMENT (RLE)

2ND SEM | FINALS transcribed by: Eyah and Trish

ASSESSING PERIPHERAL VASCULAR SYSTEM -​ inside the leg near the pelvic region.
2+ Normal, easily
PERIPHERAL VASCULAR SYSTEM consists of: ➤ POPLITEAL
identified,; not easily
➤ PERIPHERAL ARTERIES -​ behind the knee.
obliterated
-​ are responsible for oxygenated blood to get ➤ DORSALIS PEDIS
supplied from heart to all body parts -​ on the top in the middle of the foot. 3+ Increased pulse;
➤ PERIPHERAL VEINS moderate pressure for
-​ carry deoxygenated blood from the PULSE VARIABLES obliteration
extremities back to the heart. 1. RATE - number of beats per minute
●​ ADULTS: 60-90 4+ Full, bounding; cannot
PERIPHERAL PULSE LOCATIONS: -​ MEN: 60-70 obliterate
-​ WOMEN: 65-80
●​ CHILDREN OVER 7: 70-90
VARICOSE VEINS (VARICOSITIES)
●​ CHILDREN 1-7: 80-110
●​ INFANTS: 100-160

TACHYCARDIA - pulse rate too high

BRADYCARDIA - pulse rate too low

2. RHYTHM - regularity of pulse regular or irregular

●​ ARRHYTHMIA - irregular or abnormal rhythm

3. VOLUME - strength or intensity of pulse

●​ Described by words such as thready, weak, -​ swollen, twisted veins that lie just under the
strong, bounding skin.
-​ usually occur in the legs, sometimes form in
PULSE 4-POINT SCALE other parts of the body.
-​ Occur when your veins become enlarged,
GRADE DESCRIPTION
dilated, and overfilled with blood.
➤ CAROTID PULSE
0 Absent -​ typically appear swollen and raised, have a
-​ just under the chin near the larynx.
bluish-purple or red color, and can be
➤ BRACHIAL PULSE
1+ Palpable, but thready painful.
-​ inside the bend of the elbow.
and weak, easily
➤ RADIAL
obliterated DEEP VEIN THROMBOSIS
-​ located on the inside of the wrist near the
thumb.
➤ FEMORAL
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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

TREATMENT MAY INCLUDE

●​ procedures to widen the artery
●​ medications to reduce the build-up of fatty
deposits within blood vessels
●​ lifestyle changes such as weight loss and
BUERGER DISEASE regular exercise.

SYMPTOMS
-​ In some cases, a person with peripheral
vascular disease does not have any
PERIPHERAL ARTERIAL DISEASE (PAD) symptoms until the condition is advanced
-​ in the legs or lower extremities and severe.
-​ the narrowing or blockage of the vessels that -​ Symptoms depend on which body part is
carry blood from the heart to the legs. deprived of sufficient blood, but may include:
-​ Causes, Symptoms, Risk Factors, Diagnosis,
●​ INTERMITTENT PAIN (claudication)
Treatment, Prevention And Complications
RAYNAUD’S SYNDROME -​ may feel like cramps,
muscle fatigue or
3 SIGNS OF PERIPHERAL ARTERIAL DISEASE
heaviness (usually in the
1.​ Leg pain that doesn't go away when you
legs)
stop exercising.
●​ WORSENING PAIN DURING EXERCISE
2.​ Foot or toe wounds that won't heal or heal
usually in the legs
very slowly. Gangrene, or dead tissue.
●​ EASING OF PAIN DURING REST usually
3.​ A marked decrease in the temperature of
in the legs
your lower leg or foot compared to the other
●​ Coldness of the affected body part
leg or the rest of your body.
●​ Numbness
1. Skin turns white as blood flow is restricted
●​ Pins and needles
PERIPHERAL VASCULAR DISEASE
●​ Muscular weakness
-​ the reduced circulation of blood to a body
●​ Blue or purple tinge to the skin
part, other than the brain or heart, due to a
●​ Wounds that won't heal (vascular
narrowed or blocked blood vessel.
ulcers)
2. Skin turns blue as blood vessels react
●​ Blackened areas of skin or skin loss
RISK FACTORS
(gangrene).
●​ Diabetes
●​ Obesity
●​ Smoking
3. Skin turns red as blood flow returns ●​ sedentary lifestyle.
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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

ASSESSING ABDOMEN PALPATION

THE IMPORTANCE OF ABDOMINAL ASSESSMENT: -​ should be gentle but deep if there is no pain.
Although an essential component of all routine
physical examinations, the physical examination of ABNORMAL BOWEL SOUNDS
the abdomen is the key step in the evaluation of ➤ DECREASED or ABSENT BOWEL SOUNDS
abdominal complaints such as pain, distension, -​ often indicate constipation.
enlarged organs, or masses. ➤ INCREASED (HYPERACTIVE) BOWEL SOUNDS
-​ can sometimes be heard even without a
STEPS FOR ASSESSING A PATIENT'S ABDOMEN stethoscope.
●​ Assessing your patient's abdomen can -​ Hyperactive bowel sounds mean there is an
provide critical information about his increase in intestinal activity.
internal organs. -​ may happen with diarrhea or after eating.
●​ Always follow this sequence:
-​ Inspection WHAT DOES A FIRM ABDOMEN MEAN?
-​ Auscultation ABDOMINAL RIGIDITY
-​ Percussion -​ stiffness of your stomach muscles that
-​ Palpation. worsens when you touch, or someone else
A. ABDOMINAL QUADRANTS touches, your abdomen.
DOCUMENTATION OF FINDINGS: -​ an involuntary response to prevent pain
●​ Documentation of a basic, normal caused by pressure on your abdomen.
abdominal exam should look something -​ Another term for this protective mechanism
along the lines of the following: is GUARDING
-​ Abdomen is soft, symmetric, and
non-tender without distention. CAUSES OF ABDOMINAL SOUNDS
-​ There are no visible lesions or scars. -​ abdominal sounds you hear are most likely
-​ The aorta is midline without bruit or related to the movement of food, liquids,
visible pulsation. digestive juices, and air through your
intestines.
ABDOMINAL PALPATION -​ When your intestines process food, your
EXAMINING HAND abdomen may grumble or growl.
-​ should be flat on the abdomen -​ The walls of the gastrointestinal tract are
FINGERS mostly made up of MUSCLE.
-​ should be pointing upwards so that the
fingertips are on a line parallel to the PERCUSSION OF THE BELLY
expected liver edge.
B. ABDOMINAL REGIONS
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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

-​ PERCUSSION means tapping the belly and -​ When doctors push down on the belly of the
listening to the tone of different sounds. patient, the first thing they note is the
-​ When a healthcare provider taps just below consistency.
the rib cage, they can hear the sounds made -​ If bad stuff is going on in the abdominal
by a normal liver. cavity, the person involuntarily tenses
-​ Similar sounds heard when tapping beyond his/her abdominal muscles. This is known as
where the liver should be could be a sign of GUARDING
an enlarged liver.
INSPECTION OF THE ABDOMEN 1. This maneuver is performed with the patient SUPINE.
WHAT CAUSES HARD ABDOMEN? -​ look for symmetry to make sure there are no
-​ When your stomach swells and feels hard, masses or protrusions that make one side of 2. Percuss across the abdomen as for flank dullness,
the explanation might be as simple as the abdomen bigger than the other. with the point of transition from tympany to dullness
overeating or drinking carbonated drinks, noted.
which is easy to remedy. ROVSING'S SIGN
-​ Other causes may be more serious, such as -​ pain elicited in the right lower quadrant with 3. The patient then is rolled on his/her side away from
an inflammatory bowel disease. palpation pressure in the left lower quadrant the examiner, and percussion from the umbilicus to
-​ Sometimes the accumulated gas from -​ a sign of ACUTE APPENDICITIS the flank area is repeated.
drinking a soda too quickly can result in a -​ MUSCLE GUARDING, manifested as
hard stomach. resistance to palpation, increases as the SHIFTING DULLNESS
severity of inflammation of the parietal -​ is usually present if the volume of ascitic
ABDOMINAL BLOATING peritoneum increases. fluid is greater than 1500 ml.
-​ when the abdomen feels full and tight. -​ If low volume ascites is suspected, then an
-​ commonly occurs due to a buildup of gas BLUMBERG'S SIGN attempt to elicit the puddle sign may be
somewhere in the gastrointestinal (Gl) tract. -​ also referred to as REBOUND TENDERNESS or performed.
-​ causes the belly to look larger than usual, SHYOTKIN-BLUMBERG SIGN -​ In some cases, the ascites collide to form
-​ may also feel tender or painful. -​ a clinical sign in which there is pain upon bigger ascites.
-​ Fluid retention in the body can also lead to removal of pressure rather than application -​ This creates a different kind of shifting
bloating. of pressure to the abdomen. dullness.
-​ The latter is referred to simply as abdominal
SOFT BELLY tenderness PERCUSSION (for shifting dullness)
-​ Soft is good. -​ It is indicative of PERITONITIS 1.​ Percuss from the centre of the abdomen to
-​ It is good when you examine the abdomen, the flank until dullness is noted
although not too soft. SHIFTING DULLNESS 2.​ Keep your finger on the spot at which the
percussion note became dull

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

3.​ Ask patient to roll onto the opposite side to ​ Rovsing's sign- Rebound tenderness on the the patient's right thigh while applying
which you have detected the dullness left lower quadrant counter resistance to the right hip (asterisk).
4.​ Keep the patient on their side for 30 seconds ​ Psoas sign- Pain with flexion of the right leg
5.​ Repeat your percussion in the same spot at the hip 4.​ Obturator sign
6.​ If fluid was present (ASCITES) then the area ​ Obturator sign: Pain with rotation of the right
that was previously dull should now be
leg internally at the hip
resonant
7.​ If the flank is now resonant, percuss back to
TESTS FOR APPENDICITIS
the midline, which if ascites is present, will
1.​ Rebound tenderness (For peritoneal
now be dull (the dullness has shifted) -​ Pain on passive internal rotation of the flexed
irritation)
-​ Warn the patient what you are about to do. thigh. Examiner moves lower leg laterally
METHOD OF EXAMINATION (for shifting dullness) while applying resistance to the lateral side
-​ Press deeply on the abdomen with your
-​ BEGIN BY PERCUSSING AT THE UMBILICUS AND of the knee (asterisk) resulting in internal
hand. After a moment, quickly release
MOVING TOWARD THE FLANKS. rotation of the femur..
pressure.
-​ THE TRANSITION FROM AIR TO FLUID CAN BE
-​ If it hurts more when you release, the patient
IDENTIFIED WHEN THE PERCUSSION NOTE Psoas & Obturator signs
has rebound tenderness.
CHANGES FROM TYMPANIC TO DULL. -​ Pain elicited by either the psoas or obturator
-​ ROLL THE PATIENT ON THEIR SIDE AND PERCUSS maneuvers suggests irritation of the
2.​ Referred rebound tenderness
AS BEFORE. respective muscles by an inflammatory
-​ Assessment of the Abdomen Rebound
-​ THE AREA OF TYMPANY WILL SHIFT TOWARDS process such as acute appendicitis, a
Tenderness
THE TOP AND THE AREA DULLNESS TOWARDS ruptured appendix or pelvic inflammatory
-​ Pain at site is direct rebound tenderness
THE BOTTOM. disease (PID).
-​ Pain at another site is referred rebound
tenderness
FLUID WAVE TEST / ICEBERG SIGN Iliopsoas test vs. Obturator test
-​ Indicative of peritoneal inflammation
●​ Test for ascites.
-​ If in the RLQ think appendicitis (McBurney's
●​ Have patient push their hands down on the
point -- to be discussed later)
midline of the abdomen.
●​ Then you tap one flank, while feeling on the
3.​ Psoas sign
other flank for the tap.
●​ > 1 litre of fluid allows the tap to be felt on the
other side.
5.​ Hypersensitivity test

ASSESSING FOR APPENDICITIS & PERITONITIS

​ Rebound Tenderness- Pain upon removal of -​ Pain on passive extension of the right thigh.
pressure rather than application Patient lies on the left side. Examiner extends

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

Assessment of the Abdomen Cutaneous

Hypersensitivity:
-​ Either lift the skin or stimulate the skin with
gentle jabbing with a sterile pin AUSCULTATING THE ABDOMEN
-​ Indicates a zone of peritoneal irritation
-​ Percuss the lowest costal interspace in the
-​ RLQ-- appendicitis Sites for auscultating the abdomen
left anterior axillary line
-​ Mid Epigastrium-- peptic ulcer
-​ This area is normally tympanic.
-​ Ask the patient to take a deep breath and
TEST FOR CHOLECYSTITIS
percuss this area again
Murphy's sign
-​ Dullness in this area is a sign of splenic
enlargement.

NORMAL ABDOMINAL AORTA and ABDOMINAL AORTIC

ANEURYSM

-​ Typically, it is positive in cholecystitis. Percuss the spleen.

-​ It is performed by asking the patient to SPLEEN: is an oval area of dullness approximately 7
breathe out and then gently placing the cm wide near the left tenth rib and slightly posterior
hand below the costal margin on the right to the MAL.
side at the mid-clavicular line (the
approximate location of the gallbladder)

INSPECTION OF ABDOMEN
PALPATION
Inspect abdominal contour ●​ Aorta
-​ Abdomen is flat, rounded, or scaphoid
-​ Abdomen should be evenly rounded.
Splenic Dullness

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

NORMAL FINDINGS: ABNORMAL FINDINGS

●​ 5-30 bowel sounds per minute, described as ●​ Systolic and diastolic bruit: May indicate
intermittent soft clicks and gurgles. aneurysm or renal artery stenosis.
●​ BORBORYGMUS - Loud, prolonged gurgles ●​ Venous hums (rare): In the
("stomach growling"). epigastric/umbilical areas → portal
hypertension or cirrhosis.
ABNORMAL FINDINGS: ●​ Friction rubs: High-pitched, grating sounds
●​ Hyperactive bowel sounds: rushing, tinkling, over the liver or spleen: Suggest hepatic
high-pitched sounds. abscess, splenic infarction, or tumor.
1.​ Palpate using fingers from both hands ●​ May indicate gastroenteritis, early bowel
2.​ Palpate just above the umbilicus at the obstruction, diarrhea, or laxative use. III.​ PERCUSSION OF THE ABDOMEN
border of the aortic pulsation ●​ Hypoactive bowel sounds: diminished
3.​ Note the movement of your fingers: motility. General Percussion
●​ Upward movement = pulsatile ●​ Associated with paralytic ileus, peritonitis, or -​ Percuss all four quadrants lightly and
●​ Outward movement = expansile (suggestive pneumonia systematically.
of AAA) ●​ Absent bowel sounds: Emergency! May
signal a paralytic ileus or peritonitis. NORMAL FINDINGS
AUSCULTATION AND PERCUSSION OF THE ABDOMEN ●​ Generalized tympany due to intestinal gas.
CLINICAL TIPS ●​ Dullness: Over the liver, spleen, or full
I.​ AUSCULTATION OF THE ABDOMEN ●​ Bowel sounds may be more active over the bladder.
PREPARATION ileocecal valve (RLQ).
-​ Use the diaphragm of the stethoscope for ●​ Postoperative bowel activity resumes ABNORMAL FINDINGS
bowel sounds. gradually: ●​ Hyperresonance: Gaseous distention.
-​ Warm the stethoscope before placing it on ●​ Small intestine: within hours ●​ Dullness: Over mass, distended bladder, or
the abdomen. ●​ Stomach: 24-48 hours ascites.
-​ Apply light pressure or rest gently on tender ●​ Colon: 3-5 days
areas. ABDOMINAL PERCUSSION SEQUENCE
II.​ AUSCULTATION OF VASCULAR SOUNDS (A) Clockwise or
PROCEDURE -​ Using the Bell of the Stethoscope (B) Up and down over the abdomen.
-​ Begin in the Right Lower Quadrant (RLQ) and -​ Listen over: abdominal aorta, renal, iliac, and
proceed clockwise to all quadrants. femoral arteries. ABDOMINAL PERCUSSION PATTERN
-​ Listen for a minimum of 5 minutes before
concluding that bowel sounds are absent. NORMAL FINDINGS
-​ Spend at least 1 minute per quadrant. ●​ No bruits heard

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

-​ Measuring Liver Span 2.​ Lightly scratch skin toward the costal
-​ Begin at the RLQ (midclavicular line); margin.
percuss upward → tympany to dullness. This 3.​ Increase in sound intensity liver border.
is the lower border.

V. ​ SPLEEN PERCUSSION
-​ Begin posterior to the left midaxillary line,
percuss downward.

-​ Then percuss from the upper chest NORMAL FINDINGS

ABDOMINAL PERCUSSION TECHNIQUE
downward resonance to dullness. This is the ●​ Dullness ~7 cm wide near the 10th rib.
upper border.
ABNORMAL FINDINGS
NORMAL LIVER SPAN ●​ Splenomegaly >7 cm, seen in trauma, portal
HTN, mononucleosis.

VI. ​ BLUNT PERCUSSION

1.​ LIVER
-​ Place your left hand over the lower right rib
cage.
●​ At MCL: 6-12 cm
NORMAL PERCUSSION FINDINGS: -​ Strike with the ulnar side of the right fist.
●​ At MSL: 4-8 cm
NORMAL FINDINGS
●​ No tenderness
ABNORMAL FINDINGS
●​ Hepatomegaly: Enlarged liver from tumors,
ABNORMAL FINDINGS
cirrhosis, or abscess.
●​ Tenderness Hepatitis or Cholecystitis
●​ Atrophy: Smaller liver span.

2.​ KIDNEY
Position changes:
-​ Percuss at costovertebral angle (CVA) over
●​ Lower position: Emphysema
the 12th rib.
●​ Higher position: Ascites, mass, or paralyzed
NORMAL FINDINGS
●​ Blue indicates dullness. diaphragm
●​ No pain.
●​ Orange indicates tympany.
SCRATCH TEST: for difficult assessments
ABNORMAL FINDINGS
1.​ Place the stethoscope at MCL.
●​ Tenderness → Kidney infection or trauma.
VI. ​ LIVER PERCUSSION
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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

A.​ Supine ●​ Ascites can be associated with various

PERCUSSING FOR KIDNEY TENDERNESS at the B.​ Side lying conditions, including liver disease, heart
costovertebral angle. failure, and cancer.

PERFORMING LIGHT PALPATION

PERFORMING DEEP BIMANUAL PALPATION

2. ​ Fluid Wave Test
SPECIAL TEST IN ABDOMINAL ASSESSMENT
Indication: Detection of large-volume ascites.
Position: Client is supine.
I.​ TESTS FOR ASCITES

TECHNIQUE
1.​ Shifting Dullness Test
-​ Assistant or client places the ulnar edge of
Indication: Suspect ascites if the client has a
one hand midline of the abdomen.
distended abdomen or bulging flanks. PALPATING THE SPLEEN
-​ Examiner taps one side of the abdomen
Position: Client remains supine.
while feeling on the other side.
TECHNIQUE
-​ Percuss around the umbilicus. Normally,
INTERPRETATION
tympany is heard centrally and dullness
●​ No fluid wave = Negative
laterally.
●​ Palpable fluid wave= Positive test,
-​ Ask the client to turn to one side.
suggesting Ascites
-​ Reassess percussion from the bed upward. Palpating the spleen with the client in side-lying
-​ Mark where dullness shifts to tympany. position.
CLINICAL SIGNIFICANCE

INTERPRETATION ●​ The fluid wave test can be a helpful initial

●​ A marked increase in dullness height when assessment for ascites, but it is not highly
shifting positions suggests ascites. sensitive.
Note: This test is not always reliable. Ultrasound is the ●​ Ultrasound is a more sensitive and
definitive test. accurate method for confirming ascites
and assessing the volume of fluid.
PERCUSSING FOR LEVEL OF DULLNESS
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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

BIMANUAL PALPATION ASSESSING ABDOMEN pancreatitis, liver/gallbladder disease, diverticulosis, or

appendicitis?
Collecting Subjective Data Listing specific conditions helps with recall.
●​ Is part of comprehensive health history or a Urinary Tract Issues: Any history of UTIs, kidney disease,
focused interview based on a current abdominal nephritis, or stones?
complaint Recurrent infections and chronic kidney issues may cause
●​ this includes symptoms, digestive function, long-term complications.
nutrition, bowel habits, and lifestyle. Older Adults: More prone to UTIs due to reduced protective
bacteria.
ABDOMINAL PAIN
Hepatitis: History or exposure to hepatitis A, B, or C?
May lead to liver damage; risk increases for healthcare and
Use COLDSPA to assess: school personnel.
Abdominal Surgery or Trauma: Any history?
●​ Character: Type of pain (e.g., dull, sharp, burning). May result in adhesions, increasing the risk for
●​ Onset: When it started. complications.
●​ Location: Point to where it hurts.
●​ Duration: How long it lasts. Lifestyle and Health Practices
●​ Severity: Pain scale 1-10. Alcohol Use: How often and how much?
●​ Pattern: What worsens or relieves it? Can impact stomach, liver, and pancreas, causing
●​ Associated Factors: Fever, nausea, vomiting, etc. conditions like cirrhosis or gastritis.
●​ Helps identify causes such as ulcers, Diet and Fluids:
obstructions, or referred pain (e.g., back pain Typical daily food and fluid intake (including caffeine)?
from pancreas). Helps assess nutrition and hydration status; risk for
constipation or diarrhea.
1.​ Place the left palm firmly over the left costal
INDIGESTION Exercise: Frequency and type of activity?
margin posterolaterally and press it forward Promotes bowel motility and overall health.
●​ Describe symptoms (burning, bloating). Stress Levels: Type and impact on eating/elimination?
and medially.
●​ Onset, frequency, triggers (e.g., fatty food, stress). Stress affects GI motility-linked to the "brain-gut axis."
2.​ Palpate spleen with right hand starting from ●​ Associated symptoms: Nausea, vomiting, or Effect of GI Disorder on Life:
reflux. Symptoms (e.g., gas, pain, diarrhea) can affect self-esteem,
right iliac fossa social interaction, and daily functioning.
●​ May indicate GERD, ulcers, or gastric issues.

Nausea and Vomiting Purpose

ASSESSMENT OF THE ABDOMEN Conducted as part of a general checkup or to assess Gl
When it occurs and what triggers it.
PALPATION -- Fluid Wave Description of vomitus (color, presence of blood). complaints, abdominal pain, tenderness, masses, or
Related to food, motion, medications, or illness post-op status.
Assessment Sequence (Different from Other Systems)
Appetite Changes Inspection
Any increase or loss of appetite? Auscultation - done before percussion/palpation to avoid
When did the change begin? altering
Weight gain/loss or difficulty eating? bowel sounds.
Appetite loss may signal infection, cancer, depression, or Percussion
medication effects. Palpation
General Guidelines
Bowel Habits Approach from the client's right side.
Frequency and appearance of stools. Use tangential lighting for better visualization.
Any changes? (constipation, diarrhea, blood) Warm hands to avoid muscle tensing.
●​ With an assistant placing the ulnar surface of Monitor verbal and nonverbal cues for discomfort or
Use of laxatives or enemas?
their hand firmly in the midline of the patient anxiety.
Discomfort during elimination?
●​ You tap from one side to feel the wave on the Consider cultural norms and baseline patterns. Note that Combat ticklishness by placing the client's hand under
other side normal varies among individuals. yours initially
●​ Present with ascites during palpation.
GI Disorders: Have you had ulcers, GERD, IBD,
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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

Client Preparation
Ask client to empty bladder. 4.​ Inspect for Scars
Assist to lie supine, with arms at sides or across chest
(arms above head can tense muscles).
Slightly flex legs with pillow/blanket under knees.
Drape appropriately (abdomen visible from rib cage to
pubic area).
Instruct client to breathe slowly through the mouth.
Identify and assess painful areas last explain before Normal:
touching. Pale, smooth, minimally raised old scars.
Required Equipment Abnormal: Incisional hernia
Small pillow or rolled blanket Redness, inflammation, non-healing wounds.
Centimeter ruler Deep, irregular scars: May indicate burns.
Warmed stethoscope Cultural Consideration:
Marking pen Keloids more common in African Americans and Asians.
5.​ Assess for Lesions and Rashes
Common Abnormal Findings Normal:
Edema/swelling → Ascites Abdomen clear, though flat or raised brown moles may be
Masses → Tumors, stool impaction present.
Pulsations → Possible abdominal aortic aneurysm Abnormal:
Pain Could indicate appendicitis Changes in moles, bleeding, petechiae (purple/red dots):
May indicate skin or systemic disease.
1.​ Observe Skin Coloration
Normal: 6.​ Inspect Umbilicus
Abdominal skin may be paler than the rest of the body. Color:
Abnormal: Normal: Same or slightly pinker than surrounding skin. 7.​ Inspect Abdominal Contour
Grey Turner sign (purple flanks): Indicates internal bleeding Abnormal: Cullen's sign (bluish discoloration): Normal: Flat, rounded, or scaphoid (sunken in thin
(e.g., trauma, pancreatitis). Intra-abdominal bleeding. individuals).
Jaundice (yellow hue): Suggests liver issues. Location: Abnormal: Generalized distention: From fat, fluid, fetus,
Pale, taut skin: Seen in ascites. Normal: Midline. feces, flatulence, fibroids ("6 Fs").
Redness: Possible inflammation. Abnormal: Deviated (due to masses, hernia, fluid, enlarged Upper distention: From gastric dilation or pancreatic mass.
Bruising or discoloration: May indicate trauma or bleeding. organs). Contour: Lower distention: May indicate full bladder, ovarian tumor,
Normal: Inverted or slightly protruding (≤ 0.5 cm), round or or pregnancy.
2.​ Note Vascularity of Abdominal Skin conical. Scaphoid abdomen: Seen in cachexia or severe +
Normal: + Abnormal: Everted or enlarged: Suggests umbilical hernia malnutrition.
Fine veins visible; blood flow above umbilicus moves or distention.
upward, below moves downward.
Abnormal:
Dilated veins: Seen in cirrhosis, portal hypertension, Umbilical Hernia
inferior vena cava obstruction, or ascites.
Older Adults:
May have visible superficial capillaries, especially in
sunlight.
Spider angiomas (central star arterioles): Seen in liver
disease or portal hypertension.
●​ View abdominal contour from the client's side.
Many abdomens are more or less flat; and many
3.​ Inspect for Striae (Stretch Marks)
are round, scaphoid, or distended.
Normal:
Old striae: Silvery, white, linear (from weight changes or
ABDOMINAL CONTOUR
pregnancy).
●​ Flat
New striae: Pink or bluish.
●​ Rounded
Abnormal:
●​ Scaphoid (may be abnormal)
Dark bluish-pink striae: Seen in Cushing syndrome.
Epigastric Hernia ●​ Distended / Protuberant (usually abnormal)
+ Striae from ascites: Due to liver failure or disease.

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

●​ To evaluate a client's level of function with

PERSONAL HEALTH HISTORY
Activities of Daily Living (ADLs).
●​ To collect data regarding pain, stiffness, QUESTION RATIONALE
mobility, nutrition, exercise, and daily
activities. Past joint, muscle, or Establish baseline;

●​ To understand the relationship between bone injuries? assess for aftereffects.

musculoskeletal and neurologic systems.

Last tetanus and polio Stiffness may occur
immunizations? post-vaccination.
COLLECTING SUBJECTIVE DATA

HISTORY OF PRESENT HEALTH CONCERN Diagnosed with Increases risk for

diabetes, sickle cell musculoskeletal issues.
QUESTION RATIONALE
8.​ Assess Abdominal Symmetry anemia, SLE, or
Normal: Symmetrical contour. osteoporosis?
Abnormal: Asymmetry: May indicate enlarged organs, mass, Recent weight gain? Weight gain stresses
hernia, or bowel obstruction.
the musculoskeletal
Further Evaluation (Head Raise Test): For women: menopause Early menopause/low
Ask patient to raise head while lying down. system.
Normal: and hormone estrogen increases
No bulging. replacement? osteoporosis risk.
Abnormal: Difficulty chewing (pain, May indicate
Hernia or diastasis recti appears as a bulge. tenderness?) temporomandibular OLDER ADULT CONSIDERATIONS:
Mass within abdominal wall: Visible when head is raised.
Mass below wall: Less visible during this maneuver. joint (TM) dysfunction. ●​ Bones lose density with age
●​ higher fracture risk (wrists, hips, vertebrae)
9.​ Observe Respiratory Movements
Normal: Joint, muscle, or bone Helps differentiate ●​ Joint-stiffening symptoms may be
Abdominal movement with breathing (especially in males). pain (location, between bone pain misdiagnosed as arthritis
Abnormal:
Diminished movement or thoracic breathing in males: May description, onset, (deep, throbbing)
indicate peritoneal irritation. duration)? joint/muscle pain
10.​ Observe Aortic Pulsations (aching), fractures
Mo. FAMILY HISTORY
(sharp pain),
Normal:
Slight visible pulsation in epigastric area in thin osteoarthritis,
QUESTION RATIONALE
individuals.
rheumatoid arthritis, or
Abnormal:
Vigorous, wide pulsations: Suggest abdominal aortic fibromyalgia. Family history of These diseases often
aneurysm (AAA).
Older Adult Consideration:
rheumatoid arthritis, run in families.
One-time AAA screening recommended for men aged 65-75 Stiffness, swelling, Important symptoms to gout, osteoporosis?
who have ever smoked. limited movement? assess severity and
possible conditions.
ASSESSING MUSCULOSKELETAL SYSTEM
PURPOSE OF THE ASSESSMENT:

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

●​ Test ROM by demonstrating normal motion

LIFESTYLE AND HEALTH PRACTICES Difficulty performing Identifies loss of
and asking the client to actively perform the
ADLs? Use of assistive independence and
QUESTION RATIONALE movement.
devices? safety needs.
-​ Compare findings bilaterally.
Activities to promote Evaluates health
Impact on social Chronic problems affect
musculoskeletal health promotion efforts. OLDER ADULT CONSIDERATIONS:
interaction and emotional and social
(exercise, diet)? ●​ Expect slower movements, reduced flexibility,
relationships? well-being
and decreased muscle strength.
Medications taken? Some drugs (diuretics, CULTURAL NOTE:
●​ These changes are due to muscle fiber and
steroids, statins) affect LACTOSE INTOLERANCE is very common among Asians,
joint degeneration, reduced tendon
musculoskeletal health. Native Americans, and some European groups. May
elasticity, and joint capsule calcification.
affect calcium intake.
●​ If limitation in ROM is identified:
Smoking history? Smoking increases
-​ Use a GONIOMETER to measure
osteoporosis risk. COLLECTING OBJECTIVE DATA (Physical
movement in degrees (e.g., "elbow
Examination)
Alcohol or caffeine Excess contributes to flexes from 45 degrees to 90
Physical assessment of the musculoskeletal system
consumption? osteoporosis. degrees").
provides data about the client's posture, gait, bone
structure, muscle strength, joint mobility, and ability
Typical diet and Auerquate calcium, B. MUSCLES
to perform ADLs.
calcium intake? vitamin D, protein are TESTING MUSCLE STRENGTH:
critical for bone health. ●​ Ask the client to move each extremity
MAIN COMPONENTS:
through its full ROM against resistance.
Time spent in sunlight? Sun exposure aids ●​ Inspect and palpate joints, muscles, and
●​ Apply resistance against the part being
vitamin D production. bones
moved.
●​ Test range of motion (ROM)
●​ If unable to move against resistance:
Routine exercise? Weight-bearing ●​ Assess muscle strength
●​ Ask to move against gravity.
exercise strengthens
●​ If still unable, move the limb passively.
bones and muscles. 1. ASSESSING JOINTS AND MUSCLES
●​ If still not possible, inspect/feel for a
A. JOINTS
palpable contraction.
Occupation? Repetitive movements, GUIDELINES:
heavy lifting can cause ●​ Inspect size, shape, color, and symmetry.
CLINICAL TIPS:
injuries. -​ Look for masses, deformities, or
●​ Do not force joints beyond normal ROM.
muscle atrophy. Compare findings
●​ Stop if the client feels discomfort or pain.
Posture and footwear? Poor posture, improper
bilaterally.
●​ Be cautious especially with older adults.
shoes (like high heels)
●​ Palpate for edema, heat, tenderness, pain,
●​ Remember: The dominant side is usually
can cause problems.
nodules, or crepitus.
stronger.
-​ Again, compare bilaterally.
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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

-​ Demonstrate movements and give ●​ Stride, arm swing, posture

RATING SCALE FOR MUSCLE STRENGTH simple, clear verbal instructions. ●​ NUDGE TEST:
●​ Older Adult Considerations: -​ Stand behind the client,
RATING EXPLANATION STRENGTH
-​ Some exam positions may cause arms around their waist,
CLASSIFICATIO
NS discomfort. gently nudge sternum to
-​ Be sensitive and adapt techniques assess balance.
5 Active motion Normal as needed.
against full NORMAL FINDINGS:
resistance
EQUIPMENT NEEDED: ●​ Posture erect and comfortable.

4 Active motion Slight ●​ Even weight distribution.

against some Weakness ●​ Toes point straight ahead.
resistance ●​ Movements coordinated, rhythmic, stride
appropriate.
3 Active motion Average
●​ Client does not fall backward in nudge test.
against gravity Weakness

2 Passive ROM Poor ROM ABNORMAL FINDINGS:

(gravity ●​ Slumped posture (depression, poor posture).
removed and ●​ Abnormal spinal curvatures (lordosis,
1.​ Tape measure
assisted) kyphosis, scoliosis).
2.​ Goniometer
●​ Limping, shuffling, wide-based gait.
1 Slight flicker of Severe 3.​ Skin marking pen
●​ Falling backward easily (cervical
contraction Weakness
spondylosis, Parkinson's).
1. POSTURE AND GAIT
0 No muscular Paralysis PROCEDURE
contraction 2. TEMPOROMANDIBULAR JOINT (TMJ)
➤ OBSERVE POSTURE
PROCEDURE
-​ Have the client stand with feet together;
PREPARING THE CLIENT ●​ Inspect and palpate TMJ (place fingers
check head, trunk, pelvis, extremities
Ensure a comfortable room temperature. anterior to external ear opening).
●​ alignment.
Allow rest periods as needed. ●​ Ask client to:
●​ -​ Also observe while sitting.
●​ Provide adequate draping for modesty while -​ Open mouth widely.

allowing examination. -​ Move jaw side to side.

➤ OBSERVE GAIT
Explain clearly: -​ Protrude and retract jaw.
●​ -​ Watch the client walk around the room.
-​ The need to frequently change -​ Perform these movements against
-​ Note:
positions. resistance while palpating
●​ Base of support
-​ Movements to perform against temporal and masseter muscles.
●​ Weight-bearing
resistance and gravity. ●​ Foot position
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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

NORMAL FINDINGS: -​ Flexion (chin to chest)

●​ Smooth, easy opening (1-2 inches). -​ Hyperextension (look up)
●​ Lateral jaw movement (1-2 cm).
●​ Protrusion/retraction without difficulty.
●​ Snapping/clicking without pain.
●​ Strong muscle contraction.
3. STERNOCLAVICULAR JOINT
ABNORMAL FINDINGS: PROCEDURE
●​ Decreased ROM, swelling, tenderness -​ Inspect and palpate the sternoclavicular
(arthritis, TMJ dysfunction). joint for swelling, tenderness, or masses.
●​ Crepitus (grating sound) with jaw
movement. NORMAL FINDINGS: -​ Lateral bending (ear to shoulder)
●​ Weak contraction (cranial nerve V lesion, ●​ Midline location.
myofascial pain syndrome). ●​ No swelling, redness, or tenderness.

INSPECTION AND PALPATION OF TMJ ABNORMAL FINDINGS:

A. Put your index and middle fingers just anterior to ●​ Swelling, redness, enlargement, tenderness
the external ear opening and have the client open the (inflammation).
mouth.
4. CERVICAL, THORACIC, and LUMBAR SPINE
PROCEDURE
●​ INSPECT spine curves from side and behind.
-​ Rotation (turn head left and right)
●​ PALPATE spinous processes and
-​ Repeat ROM with resistance.
paravertebral muscles.
●​ Test cervical spine ROM:
TEST LUMBAR SPINE ROM:
B. Move the jaw from side to side.
A. Forward flexion (bend to touch toes).

C. PROTRUDE (push out) and RETRACT (pull in) jaw.

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

B. Adduction/Abduction
B. Lateral bending (bend sideways). E. Straight leg test (for low back pain): Raise each leg
while lying flat, dorsiflex foot at point of pain.

F. Measure leg length if asymmetry is suspected.

C. External Rotation

C. Hyperextension (bend backward).

D. Rotation (twist shoulders side to side).

5. SHOULDER, ARMS, and ELBOWS

NORMAL RANGE OF MOTION OF THE SHOULDER
A. Flexion/Extension
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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

-​ pregnancy, obesity. ●​ Firm, non-tender nodules -> RHEUMATOID

D. Internal Rotation ●​ SCOLIOSIS ARTHRITIS or RHEUMATIC FEVER
-​ lateral spine curve, unequal ●​ Tenderness/pain -> EPICONDYLITIS (e.g.,
shoulder/hip height tennis elbow).
●​ LIMITED ROM and NECK PAIN
-​ strain, arthritis, disk disease ROM TESTING:
●​ PAIN RADIATING DURING STRAIGHT LEG TEST ●​ flexion (hand to forehead), extension,
-​ herniated disc pronation (palm down), supination (palm
●​ UNEQUAL TRUE or APPARENT LEG LENGTHS up), with and without resistance.
-​ hip or pelvis abnormalities
NORMAL FINDINGS:
B. ELBOWS
INSPECTION
●​ Inspect size, shape, deformities, redness,
swelling (both flexed and extended
NORMAL FINDINGS:
positions).
●​ CERVICAL:
-​ 45° flexion and extension
NORMAL FINDINGS:
-​ 40° lateral bending;
●​ Symmetric, without deformities, redness, or
-​ 70° rotation.
swelling.
●​ LUMBAR:
-​ 75-90° forward flexion
ABNORMAL FINDINGS:
-​ 35° lateral bending
●​ Swelling, redness, enlargement, tenderness ●​ 160° flexion
-​ 30° hyperextension and rotation.
(inflammation). ●​ 180° extension
●​ Spine straight from behind
●​ cervical and lumbar curves concave
PALPATION
●​ thoracic convex.
●​ Flex elbow to ~70 degrees; palpate
●​ No tenderness or spasm in spinous
olecranon process and epicondyles with
processes or muscles.
thumb and middle finger.
●​ Equal leg lengths (within 1 cm).

NORMAL FINDINGS:
ABNORMAL FINDINGS:
●​ Nontender, no nodules.
●​ KYPHOSIS
-​ exaggerated thoracic curve in older
ABNORMAL FINDINGS:
adults
●​ LORDOSIS ●​ 90° pronation and supination
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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

●​ Full ROM against resistance

ABNORMAL FINDINGS:
ABNORMAL FINDINGS: -​ Tenderness -> SCAPHOID FRACTURE
●​ Decreased ROM against resistance
●​ Joint/muscle -> disease or injury. ROM TESTING:
●​ Flexion (bend wrist down), extension (bend
C. WRISTS ●​ Squeeze hands across knuckle joints. wrist up), ulnar/radial deviation
INSPECTION AND PALPATION (outward/inward), with resistance.
NORMAL FINDINGS:
●​ No extreme pain NORMAL FINDINGS:

ABNORMAL FINDINGS:
●​ Extreme pain -> RHEUMATOID ARTHRITIS,
PSORIATIC ARTHRITIS

●​ INSPECTION size, shape, symmetry, color,

PALPATION OF ANATOMIC SNUFFBOX
swelling.
●​ PALPATION for tenderness, nodules.

●​ 90° flexion
NORMAL FINDINGS:
●​ • 70° hyperextension
●​ Symmetric, nontender, no redness, swelling,
or nodules.

ABNORMAL FINDINGS:
●​ Swelling, tenderness -> RHEUMATOID
ARTHRITIS
●​ Nontender cyst -> GANGLION CYST
●​ Pain, swelling, grip loss -> WRIST FRACTURE

SQUEEZE TEST

●​ Palpate hollow area at thumb base.

●​ • 55° ulnar deviation
NORMAL FINDINGS: ●​ • 20° radial deviation
●​ No tenderness ●​ • Full ROM against resistance

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

●​ Flicking wrist motion -> SUGGESTS CTS ●​ Finger abduction (spread), adduction (fist),
ABNORMAL FINDINGS: flexion, hyperextension, thumb opposition.
●​ Decreased muscle strength -> D. THUMB WEAKNESS TEST
MUSCLE/JOINT DISEASE -​ Ask the client to raise thumb and stretch it NORMAL FINDINGS:
across to touch the little finger pad.
TEST FOR CARPAL TUNNEL SYNDROME
A. PHALEN TEST NORMAL FINDINGS:
-​ Flex wrists (backs of hands together) for 60 ●​ Can raise and stretch thumb easily.
seconds.
ABNORMAL FINDINGS:
NORMAL FINDINGS: ●​ Cannot raise/stretch thumb -> THUMB ●​ 20° abduction
●​ No tingling, numbness, burning, or pain. WEAKNESS IN CTS

ABNORMAL FINDINGS: D. HANDS AND FINGERS

●​ Symptoms within a minute -> CTS INSPECTION AND PALPATION
SUSPECTED ●​ INSPECT size, shape, symmetry, swelling,
color.
B. TINEL TEST ●​ PALPATE each joint and metacarpals.
●​ Full finger adduction
-​ Percuss over the median nerve at wrist.
NORMAL FINDINGS:
NORMAL FINDINGS: ●​ Symmetric, nontender, straight fingers, no
●​ No tingling/shocking sensation. nodules or swelling.

ABNORMAL FINDINGS: ABNORMAL FINDINGS:

●​ Tingling/shocking -> MEDIAN NERVE ●​ Pain, swelling, finger deformities ->
●​ 90° flexion
ENTRAPMENT (CTS) FRACTURES
●​ 30° hyperextension
●​ Swollen/tender joints -> ACUTE RHEUMATOID
C. FLICK SIGNAL ARTHRITIS
-​ Ask. "What do you do when symptoms are ●​ Boutonnière and swan-neck deformities ->
worse?" CHRONIC RHEUMATOID ARTHRITIS
●​ Thenar atrophy -> CARPAL TUNNEL SYNDROME
NORMAL FINDINGS: ●​ Heberden's and Bouchard's nodes ->
●​ No flicking motion OSTEOARTHRITIS
●​ Thumb moves easily across palm

ABNORMAL FINDINGS: ROM TESTING ●​ Full ROM against resistance

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

●​ Skip if total hip replacement unless cleared

ABNORMAL FINDINGS: by physician
●​ DUPUYTREN CONTRACTURE ●​ Hip flexion, extension, abduction, adduction,
-​ inability to extend ring/little fingers internal/external rotation, hyperextension.
●​ TENOSYNOVITIS
-​ pain with extension NORMAL FINDINGS:
●​ Decreased strength -> MUSCLE/JOINT
DISEASE ●​ 40° internal rotation
●​ 45° external rotation
6. HIPS
INSPECTION AND PALPATION

●​ 90° hip flexion (straight leg)

●​ 15° hyperextension
●​ Full ROM against resistance

ABNORMAL FINDINGS:

●​ INSPECT symmetry, shape ●​ Inability to abduct -> HIP DISEASE

●​ PALPATE for stability, tenderness, crepitus. ●​ Pain/decreased internal rotation ->

OSTEOARTHRITIS or FEMORAL NECK FRACTURE
●​ 120° flexion (knee bent)
NORMAL FINDINGS: ●​ Pain with palpation -> HIP BURSITIS

●​ Equal buttocks, symmetric iliac crests, stable,

nontender hips, no crepitus. LASEGUE (STRAIGHT LEG RAISING) TEST:

ABNORMAL FINDINGS:
●​ Instability, deformity -> HIP FRACTURE
●​ Tenderness, swelling, decreased ROM -> HIP ●​ 45-50° abduction
INFLAMMATION, DEGENERATIVE JOINT DISEASE ●​ 20-30° adduction
(DJD)
●​ Pain with movement -> GROIN/ADDUCTOR ●​ Raise one straight leg and dorsiflex foot.
STRAIN or BURSITIS
NORMAL FINDINGS:
ROM TESTING ●​ No pain.

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

●​ No fluid bulge. ABNORMAL FINDINGS:

ABNORMAL FINDINGS: ●​ Fluid wave or click -> LARGE EFFUSION,
●​ Reproduced pain -> HERNIATED DISC ABNORMAL FINDINGS: MENISCAL TEAR
●​ Fluid bulge -> SMALL JOINT EFFUSION
7. KNEES PATELLAR COMPRESSION
INSPECTION AND PALPATION -​ Slide patella distally and assess
●​ INSPECT size, shape, symmetry, swelling, crepitus/pain.
deformities, alignment.
NORMAL FINDINGS:
●​ No pain, crepitus may be present but not
painful.

-​ Stroking the knee ABNORMAL FINDINGS:

●​ PATELLOFEMORAL DISORDER

●​ PALPATE for tenderness, warmth, consistency, ROM TESTING

nodules. MOVEMENTS:
-​ Bend each knee (flexion) toward buttocks or
NORMAL FINDINGS: back.
●​ Symmetric knees, hollows beside patella, -​ Straighten the knee (extension and
-​ Observing the medial side for bulging
firm muscles, no tenderness, cool to touch. hyperextension).

BALLOTTEMENT TEST -​ Walk normally and repeat movements

ABNORMAL FINDINGS: against resistance.
●​ GENU VALGUM (knock knees), GENU VARUM
(bowed legs) NORMAL FINDINGS:
●​ Swelling -> FLUID ACCUMULATION or
SYNOVITIS
●​ Tenderness, warmth -> SYNOVITIS
●​ Asymmetric quadriceps -> MUSCLE ATROPHY
-​ for large amounts of fluid
-​ Press on each side of the patella and push it
BULGE TEST
down.
-​ for small amounts of fluid
-​ Stroke medial knee and press lateral side.
NORMAL FINDINGS:
●​ Patella rests firmly, no movement.
NORMAL FINDINGS: ●​ 120-130° flexion

21
HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

●​ 0° extension to 15° hyperextension ●​ Pain or clicking -> TORN MENISCUS

●​ Full ROM against resistance; no pain or
instability. 8. ANKLES AND FEET
INSPECTION AND PALPATION
ABNORMAL FINDINGS: ●​ INSPECT
●​ OSTEOARTHRITIS -> Decreased ROM with -​ while sitting, standing, walking
synovial thickening and crepitation. -​ Position, alignment, shape, skin -​ Palpate ankles and feet for tenderness, heat,

●​ FLEXION CONTRACTURES -> Inability to fully condition. swelling, nodules.

extend the knee. -​ Palpate toes from distal to proximal for

●​ MUSCLE/JOINT DISEASE -> Decreased NORMAL FINDINGS: tenderness, swelling, crepitus.

strength against resistance. ●​ Toes point forward and lie flat.

●​ Smooth, rounded medial malleoli; prominent NORMAL FINDINGS:

SPECIAL TEST FOR MENISCAL INJURY - MURRAY TEST heels and MTP joints. ●​ No pain, heat, swelling, or nodules.

●​ Skin smooth, no corns or calluses.

●​ Longitudinal arch present; weight distributed ABNORMAL FINDINGS:

midline. ●​ SPRAINS
-​ Tenderness at ligaments.

ABNORMAL FINDINGS: ●​ GOUTY ARTHRITIS

●​ PES VARUS -​ Tender, painful, red, hot, swollen

-​ Toes point inward. MTP joint of great toe.

●​ PES VALGUS ●​ RHEUMATOID ARTHRITIS

-​ Toes point outward. -​ Nodules of posterior ankle;

●​ HALLUX VALGUS tenderness and swelling.

PROCEDURE -​ Laterally deviated great toe, ●​ PLANTAR FASCIITIS
●​ Supine position; flex one knee and hip. overlapping second toe, bunion -​ Tenderness at calcaneus (heel
●​ Place thumb and index finger on each side formation. pain)
of Knee; hold heel with other hand. ●​ PES PLANUS
●​ Rotate lower leg and foot laterally while -​ flat feet 9. METATARSOPHALANGEAL JOINT
slowly extending the knee (then medially ●​ PES CAVUS PROCEDURE:
rotate and repeat). -​ high arches -​ Squeeze foot from each side, palpate

●​ Corns, calluses, plantar warts. metatarsals and plantar area.

NORMAL FINDINGS:
●​ No pain or clicking. PALPATION NORMAL FINDINGS:
●​ No swelling, tenderness, or pain.
ABNORMAL FINDINGS:

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

ABNORMAL FINDINGS:
●​ JOINT INFLAMMATION (RA, DJD)
-​ Pain and tenderness at MTP joints.
●​ PLANTAR FASCIITIS
-​ Tenderness at bottom of foot/heel.

●​ 20° dorsiflexion
SQUEEZE TEST ●​ 45° plantarflexion

➤ LUMBAR HYPERLORDOSIS
-​ Hip flexion contracture and hip extensor
weakness drive the lumbar spine into
increasing lordosis to balance head over
pelvis.
-​ Squeeze the midfoot across the top.
-​ Note the use of the hands for stability

NORMAL FINDINGS: ●​ 20° eversion

●​ No extreme pain. ●​ 30° inversion

ABNORMAL FINDINGS:
●​ Extreme pain -> RHEUMATOID ARTHRITIS or
PSORIATIC ARTHRITIS

ROM TESTING
MOVEMENTS
➤ KYPHOSIS
●​ DORSIFLEXION (Point toes upward)
●​ 10° abduction -​ A rounded thoracic convexity
●​ PLANTAR FLEXION (Point toes downward)
●​ EVERSION (Turn soles outward) ●​ 20° adduction
●​ INVERSION (Turn soles inward) ●​ 40° flexion of toes
●​ ABDUCTION (Rotate foot outward) ●​ 40° extension of toes
●​ ADDUCTION (Rotate foot inward)
●​ TOE FLEXION AND EXTENSION (Curl toes under ABNORMAL FINDINGS:
and stretch toes upward)

NORMAL RANGES:

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

➤ SCOLIOSIS -​ Nontender, round, enlarged, swollen,

-​ A lateral curvature of the spine with an fluid-filled cyst
increase in convexity on the side that is -​ commonly seen at the dorsum of the wrist
curved

➤ HEBERDEN NODE
-​ due to the bony overgrowth of osteoarthritis.
➤ THENAR ATROPHY
-​ Atrophy of the thenar prominence due to
➤ ACUTE RHEUMATOID ARTHRITIS pressure on the median nerve
-​ Tender, painful, swollen, stiff joints are seen -​ seen in carpal tunnel syndrome.
in acute rheumatoid arthritis

➤ BOUTONNIERE DEFORMITY
➤ BOUCHARD NODES ➤ ACUTE GOUTY ARTHRITIS

➤ SWAN-NECK DEFORMITY

➤ TENOSYNOVITIS
-​ Painful extension of a finger
-​ may be seen in acute tenosynovitis ➤ FLAT FEET (pes planus)

(infection of the flexor tendon sheaths).

➤ GANGLION
24
HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

-​ has no arch and may cause pain and

swelling of the foot surface
Precise descriptions
help differentiate types
of headaches (e.g.,
migraines, tension
headaches).

SEIZURE Helps determine seizure

➤ CORN
type (generalized,
-​ are painful thickenings of the skin that occur
Do you experience absence) and causes
over bony prominences and at pressure seizures? (Use detailed (epilepsy, metabolic
➤ HALLUX VALGUS points.​ questions.) disorders, head injury).
-​ an abnormality in which the great toe is The circular, central, translucent core
(arrows) resembles a kernel of corn. Information about aura,
deviated laterally and may overlap the
bladder control, and
second toe.
medication adherence
-​ An enlarged, painful, inflamed bursa guides diagnosis and
(bunion) may form on the medial side. Collecting SUBJECTIVE DATA safety planning.
●​ key to identifying problems because many
neurologic symptoms, like changes in ADLs, DIZZINESS / Dizziness could indicate
LIGHTHEADEDNESS carotid artery disease,
are not visible.
cerebellar disorders, or
●​ Clients may also fear serious conditions (e.g.,
Do you experience inner ear infection.
brain tumors, Alzheimer's) and worry about dizziness, balance Coordination issues
loss of control or independence. Being problems, or suggest cerebellar or
sensitive to these fears encourages better clumsiness? extrapyramidal
client communication. involvement. Increased
➤ HAMMER TOE
fall risk is a major
concern.
HISTORY OF PRESENT HEALTH CONCERNS
NUMBNESS, TINGLING PARESTHESIAS points to
QUESTION RATIONALE (paresthesias) possible damage to the
brain, spinal cord, or
HEADACHES Morning headaches Do you experience peripheral nerves,
that subside after numbness or tingling? helping localize the
Do you experience arising may signal (Use COLDSPA.) neurological deficit.
➤ PLANTAR WART headaches? (Use increased
-​ are painful warts (verruca vulgaris) that COLDSPA.) intracranial pressure
often occur under a callus, appearing as tiny (e.g., brain tumor).
dark spots.
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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

Changes in SMELL or Decreased sense of dysfunction or diseases MEMORY LOSS Recent memory loss is
TASTE smell may signal like CVA, Parkinson's, associated with
olfactory nerve myasthenia gravis, or amnesia, Korsakoff
dysfunction or brain Guillain-Barré syndrome, delirium, or
tumor. syndrome. dementia

Taste issues may LOSS OF BOWEL or Can occur with spinal Remote memory issues
involve cranial nerves Bladder Control cord injury or tumors suggest cerebral cortex
VII (facial) or IX affecting motor damage.
(glossopharyngeal). pathways.
(Normal decrease in
older adults.) Muscle Weakness or Unilateral weakness PAST HEALTH HISTORY
PARALYSIS often suggests CVA,
spinal cord
QUESTION RATIONALE
RINGING in ears May indicate cranial compression, or nerve
(TINNITUS) or HEARING nerve VIII (acoustic) injury. History of Head Injury Even mild head trauma
LOSS dysfunction. (Hearing can cause lasting
loss also occurs Progressive weakness neurological problems.
normally with aging.) may signal Details help assess risk
neurodegenerative for chronic deficits.
VISION changes Changes can signal diseases.
cranial nerve II History of NEUROLOGIC Past neurologic illnesses
dysfunction, increased INFECTIONS or can result in long-term
intracranial pressure, Involuntary Movements Tremors can be seen in conditions (MENINGITIS, physical and cognitive
brain tumors, or cranial (TREMORS, TICS, Parkinson's disease, ENCEPHALITIS, STROKE) changes that impact
nerve III, IV, or VI MYOCLONUS, CHOREA, cerebellar disorders, current health status.
involvement. Early blind ATHETOSIS) and multiple sclerosis.
spots may suggest
stroke (CVA). (Normal Tics occur in Tourette
FAMILY HISTORY
vision decline with age.) syndrome or side
effects of medications.
QUESTION RATIONALE
Difficulty Speaking Language and speech
(DYSARTHRIA, problems suggest Severe myoclonus may
Family History of These conditions can
DYSPHASIA) cerebral cortex injury indicate epilepsy.
STROKE, have genetic
(e.g.. stroke, brain
ALZHEIMER’S, EPILEPSY, components; a family
injury). Athetosis points to
BRAIN CANCER, history increases the
cerebral palsy.
HUNTINGTON’S DISEASE client's risk.
Difficulty Swallowing Dysphagia can be (Intentional tremors are
(DYSPHAGIA) associated with cranial normal in aging.)
nerve IX, X, or XII

26
HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

●​ Pupillary response
LIFESTYLE AND HEALTH PRACTICES
MENTAL STATUS ●​ Extremity movement and strength

QUESTION RATIONALE -​ Evaluates the function of the cerebral cortex, ●​ Sensation in extremities
including intellectual ability, communication, ●​ Vital signs
Use of Medications and and emotional behavior.
Prescription/Nonprescri substances can affect -​ This is often conducted at the start of the PREPARING THE CLIENT:
ption Drugs, Alcohol, neurologic function
examination for insights into the validity of
Recreational Drugs (e.g., dizziness, mood
the subjective data. ●​ Ask the client to remove jewelry and wear a
changes, sedation).
gown, explaining position changes during
SMOKING Habits Nicotine causes CRANIAL NERVES the exam.
vasoconstriction, -​ Assesses motor and sensory message ●​ Ensure the client understands that the
reducing brain transmission to the head and neck, process may take time and involve rest
perfusion and
-​ often done during head, neck, eye, and ear periods.
increasing CVA risk.
examinations. ●​ For older or weak clients, split the exam into

Use of SAFETY Seatbelts and helmets parts over two sessions

MEASURES ( Seat Belts, prevent traumatic brain MOTOR AND CEREBELLAR SYSTEMS
helmets) injuries during -​ Checks pyramidal and extrapyramidal EQUIPMENT:
accidents. tracts, balance, and coordination.
-​ This is usually part of the musculoskeletal GENERAL: Gloves, cotton-tipped applicators, reflex
NUTRITIONAL INTAKE Deficiencies (e.g.,
exam. hammer.
(diet recall) Vitamin B12) can lead
CRANIAL NERVE: Items like cotton balls, tongue
to peripheral
neuropathy and SENSORY SYSTEM depressors, tuning fork, etc.
neurologic dysfunction. -​ Assesses the integrity of spinal tracts and MOTOR AND CEREBELLAR: Tape measure.
parietal brain lobes. SENSORY: Items to feel (e.g., keys, quarter), test tubes
with hot/cold water, tuning fork.
REFLEXES REFLEX: Reflex hammer, cotton-tipped applicator.
-​ Tests deep and superficial reflexes to
evaluate the nervous system's integrity. REFLEX EXAMINATION
Collecting OBJECTIVE DATA - PHYSICAL ●​ To use a reflex hammer:
EXAMINATION -​ If MENINGITIS is suspected, signs like -​ Have the client relax.
Brudzinski and Kernig may be tested. In -​ Hold the hammer properly, palpate the
NEUROLOGIC EXAMINATION emergency cases, a neuro check (brief tendon.
neurologic assessment) is used to assess: -​ Strike briskly with a rapid wrist movement.
-​ A complete neurologic examination -​ Compare responses bilaterally.
assesses the following five areas: ●​ Consciousness level

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HEALTH ASSESSMENT (RLE)
2ND SEM | FINALS transcribed by: Eyah and Trish

-​ Use the pointed end for small areas and the ●​ Difficulty reading, visual field loss, optic disc
blunt end for larger or tender areas. changes (e.g., papilledema or atrophy)
-​ Use reinforcement techniques (e.g., could indicate retinal issues or brain tumors.
clenching the jaw) to increase reflex activity
if needed. 3.​ CN III (Oculomotor), IV (Trochlear), VI
-​ Document reflexes on a scale from 0 (no (Abducens)
response) to 4+ (hyperactive). -​ Test: Inspect eyelid margins and assess
extraocular movements. Test pupillary
CRANIAL NERVE ASSESSMENT PROCEDURE response to light and accommodation.

1.​ CN I (Olfactory) Normal:

-​ Test: Ask the client to close their eyes, ●​ Eyes move smoothly in all directions; pupils
occlude one nostril, and identify a scented constrict bilaterally in response to light.
object. Repeat for the other nostril.
Abnormal:
Normal: ●​ Ptosis, nystagmus, or limited eye movements
●​ Client correctly identifies the scent in each could indicate disorders like myasthenia
nostril. gravis, cerebellar disorders, or increased
intracranial pressure.
Abnormal: ●​ Pupillary abnormalities could indicate nerve
●​ inability to smell could indicate olfactory damage or drug effects.
tract lesions, sinus issues, or congenital loss.
Muscular EYE WEAKNESS seen in MYASTHENIA GRAVIS
2.​ CN II (Optic)
-​ Test: Use Snellen chart for vision, assess near
vision, and perform visual field testing by
confrontation. Use an ophthalmoscope to
view the retina.

Normal:
●​ Client has 20/20 vision, reads print at 14
inches, and shows a round red reflex.

Abnormal:

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