Patient seated, clinician behind patient

• Inspect and palpate the thyroid gland.

• Inspect and palpate the spine and back muscles.
• Inspect, palpate, and percuss the chest (identify dullness of the diaphragm).
• Listen to breath sounds.

Patient seated, clinician facing patient

• Perform breast assessment, first with the patient seated and then with the patient supine.

Patient supine, head of bed 30⁰

• Complete your pulmonary assessment by inspecting, palpating, and percussing across the chest. Then auscultate noting any abnormal breath sounds.

• Measure jugular venous pressure and inspect and palpate the carotid arteries; listen for bruits.
• Perform a complete cardiac assessment, including inspection and palpation of the precordium, and auscultation of heart sounds.
• Palpate the radial and brachial pulses.

Patient supine, head of bed flat

• The order for gastrointestinal assessment is inspection, auscultation, percussion, light palpation, deep palpation.
• Asses the liver and the spleen using percussion, then palpation.

• Palpate the femoral and popliteal pulses, and the inguinal lymph nodes.
• Inspect the lower extremities for edema, discoloration, ulcers, and varicose veins.
• Assess lower extremity muscles and reflexes.

Patient standing

• Examine the alignment of the spine, legs, and feet; assess range of motion.

Patient seated

• Complete any additional components of the neurologic assessment by assessing mental status, cranial nerves, motor system, sensory system, and reflexes.

Genital and rectal examinations

• Genital examinations are typically performed at the end of the physical assessment.
  • Male genitourinary assessment
  • Female genitourinary assessment
  • Digital rectal exam

PEARLS

• Do your best to ensure an environment that is quiet with good lighting.
• Be sensitive to privacy and patient modesty.
• Keep the patient informed as you move through the assessment.