1. Chapter Fourteen Physiological Assessment Pati L.H. Cox, RN, BSN, M.Ed. 1-2008

2. Holistic Assessment • Holistic assessments go beyond the physical assessment • Include all aspects of the older person’s life • Used to improve person’s overall health and happiness • Need to obtain holistic information that consists of general information about the person

3. Holistic Assessment • Holistic information • Exercise plan; eating pattern; consumption of alcohol, caffeine, and water; sleep patterns; smoking habits; stress management techniques; sexual activity; medication record

4. Physical Assessment • The physical assessment includes a history of any problems related to the system being assessed • Actual assessment consists of inspection and palpation

5. Physical Assessment • Assess by system • Head, neck, and face • History • Thyroid problems, head injury, neck injury • Inspection • Head– position, shape, size, symmetry, hair pattern • Face– facial muscles • Neck– venous distention, range of motion

6. Physical Assessment • Head, neck, and face (cont.) • Palpation • Trachea, cervical muscles, carotid pulses, edema, tenderness • Nose and sinuses • History • Problems with nose or sinuses

7. Physical Assessment • Nose and sinuses • Inspection • Size, shape, color of nose, swelling, drainage, difficulty moving air through nostrils, ability to smell • Palpation • Tenderness, masses

8. Physical Assessment • Eyes • History • Changes in vision, excessive tearing, discharge • Inspection • Symmetry of eyebrows, pupils • Redness, swelling, discharge • Perform eye exam using Snellen’s eye chart • Check glasses

9. Physical Assessment • Ears • History • Hearing loss, corrective devices, pain in ears, dizziness, drainage • Inspection • Do you have to repeat, size, shape, symmetry, lesions • Palpation • Pain or tenderness

10. Physical Assessment • Mouth and throat • History • Pain, swelling, difficulty swallowing, sensitive teeth, fit of dentures, last dental exam • Inspection and palpation • Gums pink, moist, smooth • Teeth in good repair • Dentures fit well • Gag reflex and uvula

11. Physical Assessment • Neurological • History • Headaches, shaking, trembling, confusion or memory loss, seizure disorder • Inspection • Level of orientation • Strength and symmetry of upper and lower extremities • Gait

12. Physical Assessment • Peripheral vascular • History • History of diabetes • Pain, aches, numbness, or tingling in calves, feet, buttocks, or legs • Swelling in legs at end of day

13. Physical Assessment • Peripheral Vascular • Inspection • Color of skin in upper and lower extremities • Edema in feet and legs • Venous stasis ulcers, ulceration on feet • Palpation • Skin temperature, pulses

14. Physical Assessment • Cardiac • History • Shortness of breath, chest pain • History of smoking, exercise • Inspection • Visual pulsations, lifts, heaves • Cough, shortness of breath • Cyanosis of mucous or nail beds

15. Physical Assessment • Cardiac (cont.) • Palpation • Thrills, heaves, lifts • Capillary refill • Skin temperature • Blood pressure • Auscultation • Irregular heartbeat • Murmurs

16. Physical Assessment • Respiratory • History • Difficulty breathing, cough, pneumonia, lung disease • Oxygen use • Vaccinations • Inspection • Use of accessory muscles, nasal flaring, cyanosis • Posture

17. Physical Assessment • Respiratory (cont.) • Palpation • Masses and tenderness of ribs • Auscultation • Abnormal sounds on inspiration and expiration • Crackles, wheezing, whistling, pleural friction rub

18. Physical Assessment • Gastrointestinal • History • Nutritional status, bowel habits, medications • Difficulty swallowing • Inspection • Skin lesions on abdomen or in skin folds

19. Physical Assessment • Gastrointestinal (cont.) • Auscultation • Listen to all four quadrants for bowel sounds • Palpation • Ask about possible pain in abdomen • Feel for masses or rigidity

20. Physical Assessment • Integumentary • History • Skin problems, allergies, skin regimen • Inspection • Observe entire body, including fingernails and toenails • Check for pallor, jaundice, petechiae, cyanosis, erythema • Pressure ulcers and other lesions

21. Physical Assessment • Integumentary (cont.) • Palpation • Turgor, texture, and temperature • Musculoskeletal • History • Pain in joints and back • Inspection • Observe gait, range of motion

22. Physical Assessment • Reproductive—Female • History • Prior problems with breasts • Menopause • Last pap smear • Sexual activity

23. Physical Assessment • Reproductive—Female (cont.) • Inspection • Observe breasts for symmetry, discharge from nipples, lumps, discoloration • Observe genitalia for discharge, lesions, rash, discoloration

24. Physical Assessment • Reproductive—Male • History • Changes in urinary stream • Urinary frequency or urgency • Burning on urination • Sexual activity • Inspection • Lesions, rashes, discoloration, discharge, circumcision

25. Physical Assessment • Urinary • History • Prior problems with urinary tract • Medications affecting urination • Surgeries • Renal disease • Inspection • Amount and color of urine

26. Physical Assessment • Urinary (cont.) • Palpation • Bladder distention, masses • Functional assessment • Important as physical assessment • Evaluate physical, cognitive, and social function • Evaluate strengths and deficits

27. Physical Assessment • Functional assessment (cont.) • Activities of daily living • Katz’s ADL scale • Direct observation most valid indicator • Self-care tasks • Instrumental activities of daily living • Lawton’s scale for IADLs • Home-care tasks

28. Physical Assessment • Functional assessment (cont.) • Social function • How person interacts with self, the environment, and others • Cultural and economic background