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PHYSICAL EXAMINATION

PHYSICAL EXAMINATION. Midterm Systems requirements assessment -critical elements -used on care plan -includes systems -used in hosp. CRITICAL ELEMENTS. Wash hands and gather equipment Prepare assessment area Introduce yourself and state purpose

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PHYSICAL EXAMINATION

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  1. PHYSICAL EXAMINATION

  2. Midterm Systems requirements assessment -critical elements -used on care plan -includes systems -used in hosp.

  3. CRITICAL ELEMENTS • Wash hands and gather equipment • Prepare assessment area • Introduce yourself and state purpose • Observe general appearance • Measure height and weight

  4. NEUROLOGICAL SYSTEM • LOC • Orientation • PERRLA (Pupils Equal Round Reactive to Light and Accommodation) • Sensation (light touch/temperature)

  5. Light touch

  6. CARDIOVASCULAR SYSTEM

  7. Listen at 4 sites • Take apical pulse (note rhythm /murmur) • S1, S2

  8. Assess pulses

  9. Assess for edema Assess for Homan’s sign

  10. Nailbeds • Color • Cap refill (UE/LE)

  11. RESPIRATORY SYSTEM • Assess rate/depth rhythm • Assess lung sounds 10 sites anterior/ 9 sites posterior

  12. Anterior sites

  13. Posterior sites

  14. GASTROINTESTINAL SYSTEM • Abd contour

  15. Bowel sounds • Masses • Bowel movement

  16. Genitourinary System • Bladder distention

  17. Musculoskeletal System • Gait • Bilateral hand grip • Bilateral hand strength • ROM (UE and LE)

  18. Integumentary System • Color • Texture • Turgor • Temperature • Moisture • Abnormalities

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