PHYSICAL EXAMINATION AND HEALTH ASSESSMENT
Physical Examination and Health Assessment
(RN-BSN NURN211)
Student's Name ___________________________________________
Examinee's initials: __________ Date: __________
Height _______ Weight _______ BMI_________ W/H ratio_______
General Survey:
Integument:
Head:
Eyes:
Ears:
Nose and paranasal sinuses:
Mouth and pharynx:
Neck and Lymphatics:
Breast and axilla:
Thorax and Lungs:
Peripheral Vascular System:
|Pulses | Right | Left |
|Carotid | | |
|Brachial | | |
|Radial | | |
|Femoral | | |
|Popliteal | | |
|Dorsalis pedis | | |
|Posterior tibial | | |
| 0 | 1 | 2 | 3 | 4 |
| |Markedly |Moderately | Slightly | Normal |
|Absent |Impaired |Impaired |Impaired | |
Abdomen:
Musculoskeletal:
Genitalia and Genitourinary:
Neurological:
-Mental status and speech:
Cranial Nerves:
|Cranial | |
|Nerve: |Evaluation Comments: |
| | |
| | |
|I | |
| | |
| | |
|II | |
| | |
| | |
|III, IV, VI | |
| | |
| | |
|V | |
| | |
| | |
|VII | |
| | |
| | |
|VIII | |
| | |
| | |
|IX, X | |
| | |
| | |
|XI | |
| | |
| | |
|XII | |
Motor assessment:
Sensory assessment:
Reflexes:
| | | |
|Reflexes: |R |L |
| | | |
|Biceps | | |
| | | |
|Triceps | | |
| | | |
|Brachioradialis | | |
| | | |
|Patellar | | |
| | | |
|Ankle | | |
| | | |
|Plantar | | |
| | | | | |
|0 |1 |2 |3 |4 |
| | | | | |
|Absent |Diminished |Average |Brisker than |Very Brisk |
| | | |Normal | |
Revised 10/01KH; HH 06
PHYS EXAM Documentation Form
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