Health History & Physical Examination Techniques - Cheat Sheet
Your final 30-minute rapid-fire reference for mastering health assessment fundamentals. All formulas, vital sign norms, IPPA technique sequences, interview structures, and high-yield NLE facts condensed into one exam-ready guide.
Assessment Types & Data Classification
Important facts
- Subjective data = only the client can provide; objective data = nurse observes/measures
- Database foundation: accurate assessment = valid nursing diagnoses = effective interventions
- Assessment is the first step of the nursing process (Assessment → Diagnosis → Planning → Implementation → Evaluation)
- Must differentiate between actual problems (present now) and potential/risk problems (may develop)
Key definitions
Subjective Data (Symptoms/Covert)
Example
Patient reports 'sharp, stabbing chest pain for 2 hours.'
Information stated by the client only — pain, nausea, dizziness, fatigue; cannot be observed or verified by the nurse.
Objective Data (Signs/Overt)
Example
BP 140/90, temperature 38.5°C, audible crackles in bilateral lung bases.
Measurable, observable information gathered by the nurse through examination — vital signs, physical findings, lab results.
Initial/Comprehensive Assessment
Example
Detailed assessment of a newly admitted patient covering all body systems and detailed health history.
Complete head-to-toe health history and physical examination performed on admission or initial client contact.
Focused/Problem-Oriented Assessment
Example
Respiratory system focus for a client with dyspnea; cardiovascular focus for chest pain.
Targeted evaluation of a specific complaint or body system related to the client's chief concern.
Emergency Assessment
Example
Immediate assessment of an accident victim before transport to hospital.
Rapid evaluation using ABC (Airway, Breathing, Circulation) priority in acute/critical situations.
Ongoing/Time-Lapsed Assessment
Example
Vital signs rechecked every 4 hours post-op; neurological checks after head injury.
Reassessment performed at intervals to monitor status changes, response to treatment, or progression of illness.
Diagrams to know
- Nursing Process cycle showing assessment as first step
- Data classification hierarchy: Subjective vs Objective
Health History Interview Structure & Communication
Important facts
- Interview has 4 phases: Preparatory → Introductory → Working (body) → Closing
- OLD CARTS: Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity — use for any symptom analysis
- PQRST (alternative): Provocation/Palliation, Quality, Region/Radiation, Severity, Timing — especially for pain assessment
- Always use OPEN-ENDED questions first to gather rich data; use CLOSED-ENDED to verify facts
- Non-therapeutic blocks: leading questions, 'why' questions sounding accusatory, false reassurance, subject-changing, medical jargon
- In Philippine context: respect for elders (use 'po'/'opo'), family involvement in decisions, hiya (shame/reticence) affects disclosure — especially sexual/mental health
- Never rush; inadequate time = incomplete history + loss of rapport
- Ensure privacy, adequate lighting, minimal noise, comfortable temperature
- Explain purpose and obtain informed consent before proceeding with exam
Key definitions
Chief Complaint (CC)
Example
'I've had a bad headache for 3 days' or 'My leg is swollen.'
The reason for seeking care, stated in the client's own words, usually brief (typically 1–3 sentences).
History of Present Illness (HPI)
Example
Uses OLD CARTS or PQRST mnemonics to describe onset, location, duration, character, aggravating/relieving factors, timing, severity.
Systematic, detailed analysis of the chief complaint using chronological narrative and symptom characteristics.
Open-Ended Question
Example
'Tell me about your usual daily diet' or 'How has this pain affected your daily life?'
Question that cannot be answered with 'yes' or 'no'; encourages the client to provide narrative, detailed information.
Closed-Ended Question
Example
'Do you take your medication every day?' or 'Are you allergic to penicillin?'
Question requiring a specific, brief answer (usually yes/no or a single fact); used to verify or obtain specific data.
Therapeutic Communication
Example
Using silence, paraphrasing, and non-judgmental responses to help the client feel heard and safe.
Purposeful, client-centered interaction using active listening, reflection, clarification, and empathy to build trust.
Diagrams to know
- Four phases of the interview process
- OLD CARTS mnemonic for symptom analysis
- PQRST mnemonic for pain assessment
- Therapeutic vs non-therapeutic communication techniques
Components of Complete Health History
Important facts
- Health history order: CC → HPI (using OLD CARTS/PQRST) → Past History → Family History → ROS → Lifestyle/Psychosocial
- ROS is SUBJECTIVE only — documents what the client reports, not what you observe
- Allergies must include type of reaction (rash, anaphylaxis, GI upset) not just 'allergic to'
- Drug allergies supersede drug benefits — always clarify reaction type; 'upset stomach' ≠ true allergy
- Immunization history important: DPT, Polio, BCG (Philippines routine schedule), tetanus status for wound assessment
- Medications: ask about prescription, OTC, herbal, and traditional remedies — all can interact
- Family history: ask specifically about 'cancer, heart disease, diabetes, high blood pressure, stroke' — common hereditary conditions
- Genogram: simple tool showing family structure and disease distribution across generations
Key definitions
Biographic Data
Example
Maria Santos, 45 years old, female, widowed, elementary school teacher, Catholic.
Demographic information: name, age, sex, address, civil status, occupation, religion (if relevant to care).
Past Health History
Example
Measles at age 6, appendectomy 2015, DPT vaccination complete, NKDA (no known drug allergies).
Record of childhood illnesses, adult illnesses, injuries, surgeries, hospitalizations, immunization status, and allergies.
Family Health History
Example
Mother: Type 2 diabetes; Father: hypertension; Brother: asthma. Grandfather (maternal side): coronary artery disease.
Information on heritable and communicable diseases in immediate and extended family; often presented as a genogram.
Review of Systems (ROS)
Example
General: 'Any recent weight loss?' HEENT: 'Vision changes?' CV: 'Chest pain or palpitations?' Respiratory: 'Cough or shortness of breath?'
Systematic, head-to-toe series of targeted questions about each body system to identify symptoms the client has not mentioned.
Lifestyle & Psychosocial Data
Example
Works 8 hours daily, exercises 3×/week, sleeps 6–7 hours nightly, occasional wine, denies smoking, married with 2 children.
Information about diet, physical activity, sleep patterns, substance use (tobacco, alcohol, drugs), occupation, coping mechanisms, stress, and functional patterns.
Diagrams to know
- Complete health history component sequence
- Genogram format for family health history
- ROS template (questions by body system)
General Survey & Vital Signs
Formulas
BMI = Weight (kg) / Height (m)²
Meaning
Weight in kilograms divided by height in meters squared; metric standard for body mass assessment.
Watch out
Must convert imperial to metric first (1 kg = 2.2 lb; 1 m = 39.37 inches or 3.28 feet); easy to confuse numerator/denominator.
When to use
Every initial assessment; use to categorize nutrition status as part of general survey.
Common values
Value
36.5–37.5°C (average 37°C / 98.6°F)
Symbol
T
Quantity
Normal Adult Temperature (Oral)
Value
60–100 beats per minute (regular)
Symbol
P
Quantity
Normal Adult Pulse
Value
12–20 breaths per minute
Symbol
RR
Quantity
Normal Adult Respirations
Value
<120/80 mmHg (systolic/diastolic)
Symbol
BP
Quantity
Normal Adult Blood Pressure
Value
95–100%
Symbol
SpO₂
Quantity
Normal SpO₂ (Room Air)
Value
18.5–24.9 kg/m²
Symbol
BMI
Quantity
Normal BMI Range
Value
+0.5°C above oral
Symbol
ΔT(rectal)
Quantity
Rectal Temperature Elevation
Value
–0.5°C below oral
Symbol
ΔT(axillary)
Quantity
Axillary Temperature Decrease
Important facts
- General survey components: appearance (age, hygiene, distress signs) → body structure/nutrition → mobility → behavior/mental status
- BMI categories: Underweight <18.5, Normal 18.5–24.9, Overweight 25–29.9, Obese ≥30 kg/m²
- Adult vital sign norms (memorize exactly): Temp 36.5–37.5°C oral (avg 37°C); Pulse 60–100/min regular; RR 12–20/min; BP <120/80 mmHg (normal), 120–129 systolic + <80 diastolic = elevated
- SpO₂: 95–100% on room air is normal; <90% indicates hypoxemia
- Temperature sites & variations: Oral (baseline ~37°C); Rectal +0.5°C higher; Axillary –0.5°C lower; Tympanic ±0.5°C accuracy varies
- Pulse: assess rate, rhythm, and amplitude; palpate radial (most common), carotid, apical, dorsalis pedis, or other sites per protocol
- Respirations: count for 60 seconds; note rate, depth (shallow/deep), and effort (labored/unlabored); abnormal patterns: bradypnea (<12), tachypnea (>20), dyspnea (difficult breathing)
- Blood pressure: systolic = pressure during ventricular contraction; diastolic = pressure during ventricular relaxation; take bilaterally, upper arm at heart level, use correct cuff size
- Pain assessment: use 0–10 numeric scale (adult), Wong-Baker FACES (children), FLACC (non-verbal), or descriptive scale per facility protocol
- Anthropometric baseline essential: weight, height, BMI, skinfold measurements (if indicated) for nutritional status
Key definitions
General Survey
Example
Apparent age, hygiene/grooming, signs of distress, body symmetry, gait, level of consciousness, mood, affect.
Overall first impression of the client's physical appearance, body structure, mobility, and behavior; begins the moment you see the client.
Vital Signs
Example
T 37.2°C, P 78/min regular, RR 16/min, BP 118/76 mmHg, SpO₂ 97% RA, Pain 0/10.
Objective measurements of basic physiologic functions: temperature, pulse, respirations, blood pressure, and pain ('fifth vital sign').
Diagrams to know
- BMI classification chart
- Vital signs normal ranges (adult)
- General survey observation checklist
Physical Examination Techniques (IPPA)
Common values
Value
~1 cm into tissues
Symbol
Palpation₍light₎
Quantity
Light Palpation Depth
Value
~4 cm into tissues
Symbol
Palpation₍deep₎
Quantity
Deep Palpation Depth
Important facts
- IPPA SEQUENCE FOR ALL REGIONS EXCEPT ABDOMEN: Inspection → Palpation → Percussion → Auscultation
- IPPA SEQUENCE FOR ABDOMEN ONLY: Inspection → Auscultation → Percussion → Palpation (to avoid altering bowel sounds)
- Hand use by part: Fingertips/pads = fine touch, texture, pulses, edema; Dorsum (back) = temperature; Ulnar edge/palmar surface = vibration (fremitus); Grasping fingers = mass position/consistency
- ALWAYS warm hands before palpating; ALWAYS palpate tender areas LAST to avoid guarding
- Light palpation BEFORE deep palpation; never palpate or percuss abdomen first (alters bowel sounds)
- Percussion sounds in order of density: Tympany (air-filled, loud) → Resonance (air-filled lung, normal) → Hyperresonance (abnormal, emphysema/pneumothorax) → Dullness (dense organ) → Flatness (bone/muscle, softest)
- Resonance over lung is NORMAL; dullness over lung is ABNORMAL (consolidation, effusion, atelectasis)
- Hyperresonance is abnormal in adults (emphysema, pneumothorax, asthma); resonance expected
- Stethoscope: Diaphragm (flat side) = high-pitched sounds (breath, heart S1/S2, bowel); Bell (cup side) = low-pitched (S3, S4, murmurs, bruits)
- Always apply bell lightly; never listen through clothing; warm stethoscope first; eliminate background noise
- Inspection begins during interview and continues throughout entire exam
- Compare bilateral regions for symmetry; asymmetry may indicate pathology
Key definitions
Inspection
Example
Observing skin color and turgor, noting bilateral symmetry of chest wall, identifying position of surgical incision.
Deliberate, systematic visual observation (and occasionally olfactory/auditory) of the client to note color, size, shape, symmetry, position, movement, and lesions.
Palpation
Example
Feeling for enlarged lymph nodes, assessing skin temperature, detecting abdominal masses or organ enlargement.
Use of touch to assess texture, temperature, moisture, turgor, pulsations, masses, tenderness, organ size, and consistency.
Percussion
Example
Tapping the chest to detect hyperinflation; tapping the abdomen to assess for free fluid; tapping over liver to estimate size.
Striking body surface to produce sounds that reveal density of underlying tissue; helps identify organ borders and pathology.
Auscultation
Example
Listening for normal S1/S2 heart sounds, bilateral breath sounds, bowel sounds after abdominal surgery, carotid bruits.
Listening to body sounds (usually with a stethoscope) to assess heart sounds, breath sounds, bowel motility, and vascular flow.
Light Palpation
Example
Initial abdominal exam to identify superficial masses, tender areas, or skin texture changes before deep palpation.
Gentle palpation using fingertip pressure about 1 cm in depth; used first to assess surface characteristics and tenderness.
Deep Palpation
Example
Palpating liver edge, spleen, kidneys, or assessing for rebound tenderness (sign of peritoneal irritation).
Firm palpation pressing approximately 4 cm into tissues; used after light palpation to assess organs, deep masses, and rebound tenderness.
Diagrams to know
- IPPA sequence for non-abdominal regions
- IPPA sequence for abdominal region (different order)
- Percussion sound spectrum by tissue density
- Hand parts and what they assess
- Stethoscope diaphragm vs bell use
Percussion Sounds & Clinical Significance
Important facts
- Resonance over lung = NORMAL; dullness or hyperresonance over lung = ABNORMAL
- Dullness over lung field suggests: consolidation (pneumonia), pleural effusion, atelectasis, or mass
- Hyperresonance over lung suggests: emphysema, pneumothorax, acute asthma, or air trapping
- Tympany expected over stomach/gas-filled bowel; ABNORMAL if heard over lung (hollow lung artifact)
- Percussion sounds in order of loudness/pitch: Hyperresonance (loudest) → Resonance → Dullness → Flatness (quietest)
- Percussion sounds related to tissue density: More air = louder/higher; More solid = softer/lower
- To percuss properly: use indirect (mediate) method — place left hand flat on client's chest, strike left middle finger with right middle finger; listen to resulting sound
Key definitions
Tympany
Example
Normal over epigastric area (stomach) and lower left abdomen (colon with gas); indicates hollow air-filled space.
Loud, drum-like, high-pitched percussion sound heard over air-filled organs (stomach, gas-filled bowel loops).
Resonance
Example
Expected over all lung fields during chest percussion; indicates healthy, aerated lung tissue.
Low-pitched, hollow, clear percussion sound heard over normal air-filled lung tissue; NORMAL finding over lungs.
Hyperresonance
Example
Heard over hyperinflated lungs in COPD or pneumothorax; abnormal finding requiring follow-up.
Booming, extremely low-pitched, louder-than-normal percussion sound; ABNORMAL in adults; indicates trapped air (emphysema, pneumothorax, asthma exacerbation).
Dullness
Example
Normal over liver (RUQ), spleen (LUQ), or full bladder (suprapubic); ABNORMAL over lung field (suggests consolidation, pleural effusion, or atelectasis).
Medium-pitched, thud-like percussion sound heard over solid/dense organs (liver, spleen, heart, full bladder) or abnormal lung consolidation.
Flatness
Example
Heard over bones, solid muscle mass, or large pleural effusion; indicates complete absence of air.
Soft, very short, barely audible percussion sound heard over very dense tissue (bone, muscle, fluid); least resonant sound.
Diagrams to know
- Percussion sound spectrum by tissue type
- Percussion findings: normal vs abnormal by region
- Clinical significance of percussion sounds in lungs and abdomen
Client Preparation, Positioning & Environment
Important facts
- Always explain procedures to reduce anxiety and obtain informed consent before exam
- Environment essentials: Privacy (closed door/curtain) → Warm room temperature → Adequate lighting → Minimal noise → Equipment within reach
- Position matches body region: Fowler's for head/neck/thorax/heart; Supine for abdomen/anterior chest; Dorsal recumbent for relaxed abdomen; Sims' for rectum; Lithotomy for pelvic/vaginal; Standing for gait/balance
- Always consider client tolerance: reposition frequently for frail/dyspneic clients; never force uncomfortable positions
- Drape appropriately: expose only the region being examined; maintain dignity by covering other areas
- Have client void before abdominal examination to ensure bladder emptiness and avoid discomfort/false findings
- Equipment ready: stethoscope, sphygmomanometer, penlight, thermometer, tape measure, reflex hammer, tuning fork, otoscope, ophthalmoscope, gloves, lubricant
- Standard precautions: hand hygiene before/after contact, gloves for body fluid contact or non-intact skin, proper disposal of sharps/biohazards
- Warm equipment (stethoscope, hands) before contact with client
- Assess pain continuously; stop or modify exam if client shows distress
Key definitions
Fowler's Position
Example
Client seated upright on examination table for inspection and palpation of chest, heart, lungs, and neck.
Semi-upright sitting position (45–60° angle); used for head, neck, thorax, heart, and upper extremities examination.
Supine Position
Example
Client lies flat for abdominal palpation, percussion, and auscultation; provides access to entire abdomen.
Flat on back, legs extended; used for abdominal and anterior chest examination.
Dorsal Recumbent Position
Example
Alternative supine position for anxious or older clients; easier on spine and allows better muscle relaxation.
Flat on back with knees bent and feet flat on surface; relaxes abdominal muscles for a more comfortable abdominal exam.
Sims' Position
Example
Client positioned on left side to access rectum and lower GI tract for digital rectal exam.
Left side-lying with left leg extended, right knee bent; used for rectal examination.
Lithotomy Position
Example
Gynecological exam positioning; client draped appropriately for privacy and dignity.
Flat on back, knees bent and legs elevated in stirrups; used for female pelvic and vaginal examination.
Standing Position
Example
Observe walking pattern, test balance (Romberg), assess spinal curvature and range of motion.
Upright; used to assess gait, balance, spine alignment, and musculoskeletal function.
Diagrams to know
- Client positioning by examination type
- Proper draping techniques by position
- Equipment setup and checklist
Documentation, Legal, & Safety Standards
Important facts
- Document findings promptly, accurately, and objectively; avoid charting interpretations as observations
- Use precise, measurable descriptions: '2 cm × 3 cm firm, nontender, mobile mass in right axilla' instead of 'lump in armpit'
- Use institutionally approved documentation format: Narrative, SOAP (Subjective-Objective-Assessment-Plan), Focus/DAR (Data-Action-Response), or electronic health record protocol
- All documentation must comply with RA 9173 and institutional policy; records are legal documents
- Maintain client confidentiality per Data Privacy Act of 2012 and nursing ethics; do not share health information without consent
- Hand hygiene: perform before and after client contact, before sterile procedures, after contact with body fluids or contaminated surfaces, and after removing gloves
- Standard precautions apply to all clients: treat all blood, body fluids, secretions as potentially infectious
- Use gloves when: contact with blood, body fluids, non-intact skin anticipated; change gloves between clients; hand hygiene after glove removal
- Proper sharps disposal: use designated sharps container, never recap needles, never break needles by hand
- Maintain dignity: appropriate draping, privacy, respect for cultural beliefs, explain procedures
- Report findings promptly to supervisor or physician if abnormal or urgent
Key definitions
Objective Documentation
Example
Instead of 'looks sick,' write 'appears anxious, BP 150/95, skin cool and diaphoretic, respirations 22/min labored.'
Recording only what was directly observed/measured by the nurse, using precise, measurable descriptions without interpretation.
RA 9173 (Philippine Nursing Act of 2002)
Example
Nurses must follow standards of care, document accurately, maintain client confidentiality, and comply with Code of Ethics for Registered Nurses.
Philippine law regulating nursing practice, licensure, professional standards, and scope of practice; nurses must maintain confidentiality and accurate records.
Code of Ethics for Registered Nurses (Philippines)
Example
Nurses must treat all clients with respect, maintain privacy of health information, practice within scope, and seek supervision when needed.
Professional ethical standards for Filipino nurses emphasizing respect for human dignity, confidentiality, competence, accountability, and professional integrity.
Diagrams to know
- Documentation standards and requirements
- Hand hygiene protocol steps
- Standard precautions checklist
NLE High-Yield Concepts — Mnemonics & Quick Recall
Important facts
- IPPA order is IPPA for lungs/heart/extremities; IAAP (different order) for abdomen to preserve bowel sounds
- Subjective = client states (symptom); Objective = nurse observes/measures (sign)
- General survey begins at first visual contact; continues throughout entire exam
- Hand parts: fingertips for texture/pulses; dorsum for temperature; ulnar edge for vibration (fremitus)
- Vital signs: T 36.5–37.5°C, P 60–100/min, RR 12–20/min, BP <120/80 mmHg, SpO₂ 95–100%, Pain 0–10
- BMI normal range: 18.5–24.9 kg/m² (easy to confuse with weight/height ratio — it's weight divided by height squared)
- Percussion: NORMAL lung = resonance; ABNORMAL lung = dullness (consolidation) or hyperresonance (air trapping)
- Stethoscope: diaphragm for high sounds, bell for low sounds; warm it and apply to bare skin
- Assessment → Diagnosis → Planning → Implementation → Evaluation (nursing process order)
- Cultural sensitivity in Philippines: use honorific 'po/opo' with elders, involve family, recognize hiya affecting health disclosure
- RA 9173 compliance: accurate documentation, client confidentiality, scope of practice, Code of Ethics
Key definitions
OLD CARTS
Example
Chest pain analysis: Onset (sudden at 2 PM) → Location (central chest) → Duration (30 min) → Character (sharp, pressure) → Aggravating (deep breath) → Relieving (rest) → Timing (intermittent) → Severity (7/10).
Mnemonic for systematic symptom analysis: Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity.
PQRST
Example
Pain provoked by (activity/food?), Quality (sharp/dull/aching?), Region (where located and does it radiate?), Severity (1–10 scale), Timing (constant/intermittent/nighttime?).
Alternative mnemonic for pain/symptom analysis: Provocation/Palliation, Quality, Region/Radiation, Severity, Timing.
ABC Priority
Example
Accident victim: check for patent airway, assess respiratory effort, assess heart rate/BP; manage life threats before detailed exam.
Emergency assessment sequence: Airway → Breathing → Circulation; prioritizes life-threatening conditions in acute situations.
Diagrams to know
- OLD CARTS breakdown with clinical example
- PQRST breakdown with clinical example
- ABC emergency assessment priority sequence
Must remember
- IPPA ORDER differs by region: Inspection → Palpation → Percussion → Auscultation for lungs/heart/neck/extremities; BUT Inspection → Auscultation → Percussion → Palpation for ABDOMEN ONLY (to preserve bowel sounds).
- SUBJECTIVE = client states (symptom); OBJECTIVE = nurse observes/measures (sign) — this distinction appears in nearly every NLE exam question about data collection.
- VITAL SIGNS normal ranges (adult): Temperature 36.5–37.5°C oral, Pulse 60–100/min, Respirations 12–20/min, Blood Pressure <120/80 mmHg, SpO₂ 95–100%, Pain 0–10 — must memorize exactly; 1°C or 5 bpm off changes answers.
- BMI FORMULA = Weight (kg) ÷ Height (m)² with normal range 18.5–24.9 kg/m² — commonly asked; easy to miscalculate if not converting imperial correctly.
- PERCUSSION SOUNDS mapped to tissue density: Hyperresonance (abnormal lung) → Resonance (normal lung) → Dullness (solid organ) → Flatness (bone); DULLNESS OVER LUNG FIELD = ABNORMAL (consolidation/effusion/atelectasis).
- PALPATION TECHNIQUE: Warm hands first, LIGHT palpation (1 cm depth) BEFORE deep palpation (4 cm depth), palpate TENDER AREAS LAST to avoid guarding — failing to follow this order gives false findings.
- STETHOSCOPE PARTS: Diaphragm (flat, high-pitched sounds: breath, normal heart sounds S1/S2, bowel) vs Bell (cup, low-pitched sounds: murmurs, S3/S4, bruits) — applied lightly; never listen through clothing.
- HEALTH HISTORY COMPONENTS in order: Biographic data → Chief Complaint → History of Present Illness (using OLD CARTS/PQRST) → Past Health History → Family History → Review of Systems (ROS is subjective only) → Lifestyle/Psychosocial — missing even one is incomplete assessment.
- GENERAL SURVEY observed AT FIRST CONTACT: Physical appearance (age, hygiene, distress), Body structure/nutrition (stature, symmetry, BMI), Mobility (gait, ROM), Behavior (LOC, mood, affect, speech) — this is objective data foundation.
- RA 9173 COMPLIANCE & DOCUMENTATION: Record objectively without interpretation, maintain confidentiality per Data Privacy Act, use precise measurable descriptions, document promptly, comply with Code of Ethics for Registered Nurses — legal liability if not followed.
Last minute tips
- When you see 'IPPA' in an NLE question, ALWAYS check the body region: if it says 'abdomen,' the order is DIFFERENT (I→A→P→P, not I→P→P→A). This single mistake costs points on nearly every assessment exam.
- Memorize vital sign normal ranges EXACTLY as given (36.5–37.5°C, 60–100/min, 12–20/min, <120/80 mmHg, 95–100% SpO₂) — exam questions use these precise cutoffs; being off by 1 unit gives a wrong answer.
- In Philippine context, NLE questions about client interviews will ask about cultural sensitivity — remember hiya (shame affecting disclosure), use of 'po/opo' with elders, family involvement in decisions. Questions about Filipino clients emphasize respect and family-centered care.
- Percussion sound questions are HIGH-YIELD: If dullness is heard over the lung field, it is ALWAYS abnormal (consolidation, effusion, atelectasis) — this is tested repeatedly. Resonance = normal lung; anything else = pathology.
- Never confuse 'sign' (objective: BP 140/90, crackles) with 'symptom' (subjective: 'I feel dizzy'); NLE asks 'What is a sign of...' vs 'What is a symptom of...' — answering wrong loses points on nursing diagnosis selection.
Comparison tables
IPPA Sequence: Regular Regions vs Abdomen
| Examination Region | Sequence | Rationale |
|---|---|---|
| Lungs, Heart, Neck, Extremities | Inspection → Palpation → Percussion → Auscultation | No risk of altering sounds; palpation/percussion does not interfere with findings |
| Abdomen | Inspection → Auscultation → Percussion → Palpation | Palpating or percussing first can distort bowel sounds; must listen before manipulating |
Percussion Sounds & Clinical Significance
| Sound | Pitch/Volume | Normal Location | Abnormal Finding |
|---|---|---|---|
| Hyperresonance | Booming/Very low | ABNORMAL in adults | Emphysema, pneumothorax, asthma (trapped air) |
| Resonance | Low/Hollow | Normal lung fields (anterior, posterior, lateral thorax) | Dullness/hyperresonance over lungs = abnormal |
| Dullness | Medium/Thud-like | Over liver (RUQ), spleen (LUQ), heart, full bladder | Over lung = consolidation, effusion, atelectasis; over abdomen = fluid/solid |
| Tympany | Loud/Drum-like | Over stomach, gas-filled bowel (epigastric, lower left) | Over lung = abnormal; indicates air-filled space |
| Flatness | Soft/Barely audible | Over bone, muscle, large effusion | Indicates very dense tissue; least resonant |
Vital Signs: Normal Adult Values & Abnormalities
| Vital Sign | Normal Range (Adult) | Below Normal (Hypo-) | Above Normal (Hyper-) |
|---|---|---|---|
| Temperature | 36.5–37.5°C (oral) | Hypothermia <36.5°C (exposure, shock, sepsis) | Fever/Hyperthermia >37.5°C (infection, inflammation, MI) |
| Pulse (Rate) | 60–100 bpm, regular | Bradycardia <60 (athletes, heart block, vagal stimulation) | Tachycardia >100 (pain, fever, anemia, hyperthyroidism, exercise) |
| Respirations | 12–20 breaths/min | Bradypnea <12 (opioids, CNS depression, hypothermia) | Tachypnea >20 (fever, pain, hypoxia, anxiety, metabolic acidosis) |
| Blood Pressure | <120/80 mmHg (normal); 120–129/<80 (elevated) | Hypotension <90 systolic (shock, dehydration, bleeding) | Hypertension ≥130/80 (chronic HTN, stress, pain, CAD risk) |
| SpO₂ (Room Air) | 95–100% | Hypoxemia <90% (respiratory/cardiac disease, anemia) | >100% impossible without supplemental oxygen |
Open-Ended vs Closed-Ended Questions
| Question Type | Structure | When to Use | Example |
|---|---|---|---|
| Open-Ended | Cannot be answered 'yes/no'; requires narrative response | START the interview; gather rich subjective data; explore feelings/experiences | 'Tell me about your headache.' 'How has this affected your daily life?' 'Describe your diet.' |
| Closed-Ended | Answered 'yes/no' or with specific facts; brief answer | VERIFY specific facts; focus discussion; obtain baseline data quickly | 'Do you take your medication daily?' 'Are you allergic to penicillin?' 'Do you smoke?' |
Physical Examination Positions & Regions
| Position Name | Body Placement | Regions Examined | Client Comfort Notes |
|---|---|---|---|
| Fowler's / Semi-Fowler's | Upright, 45–60° angle | Head, neck, thorax, heart, lungs, upper extremities | Natural, comfortable for most clients |
| Supine | Flat on back, legs extended | Abdomen, anterior chest, extremities | May cause back discomfort; use small pillow under knees if tolerated |
| Dorsal Recumbent | Flat on back, knees bent, feet flat | Relaxed abdominal examination | Easier on lower back; relaxes abdominal muscles; preferred for anxious clients |
| Sims' (Left side-lying) | Left side, left leg extended, right knee bent | Rectum, lower GI, perineal area | Exposes rectal area; dignity maintained with draping |
| Lithotomy | Flat on back, knees flexed, legs in stirrups | Female pelvic and vaginal examination | Uncomfortable/embarrassing; explain purpose, maintain privacy, use curtain, minimize time |
| Standing | Upright, feet together or shoulder-width apart | Gait, balance, musculoskeletal alignment, spine | Test balance (Romberg), assess spinal curves, observe natural posture |
Hand Parts Used in Palpation & What They Assess
| Hand Part | Sensitivity | What It Assesses | Clinical Example |
|---|---|---|---|
| Fingertips/Pads | Highest discriminatory touch | Texture, consistency, fine detail, pulses, edema, masses | Detecting lymph node enlargement, assessing skin turgor, feeling pulse amplitude |
| Dorsum (Back of Hand) | Temperature-sensitive (thinner skin) | Skin temperature, temperature differences between areas | Comparing skin temperature bilaterally, detecting fever by touch |
| Ulnar Edge / Palmar Surface | Detects vibration | Tactile fremitus (chest vibration from lung sounds), vibration sensation | Assessing chest wall vibration during speech/cough (pneumonia vs normal) |
| Grasping Fingers | Bimanual control | Position, movement, mobility of masses or organs | Assessing kidney mobility, evaluating mass size/fixation, palpating thyroid |
Common Non-Therapeutic Communication Blocks
| Block | Definition | Why It's Problematic | Example to Avoid |
|---|---|---|---|
| Leading Questions | Question suggests the answer the nurse expects | Biases client response; gets 'yes' answer without genuine information | 'You don't drink alcohol, do you?' (suggests no; client may agree falsely) |
| Accusatory 'Why' Questions | 'Why did you...?' phrasing sounds judgmental | Client feels blamed; becomes defensive; closes off communication | 'Why didn't you take your medication?' (sounds accusatory; client clams up) |
| False Reassurance | Minimizing client concern without basis | Client feels unheard; trust erodes; real fears not addressed | 'Don't worry, you'll be fine' (without assessment; may not be true) |
| Subject-Changing | Abruptly shifting topic away from client concern | Client feels dismissed; important data lost; rapport broken | Client mentions anxiety; nurse says 'Let's check your blood pressure' (avoids anxiety) |
| Medical Jargon | Using complex medical terminology with client | Client does not understand; embarrassed to ask; gives vague 'yes' answers | 'Do you have dyspnea?' instead of 'Are you short of breath?' |
Diagrams
IPPA Physical Examination Sequence Decision Tree
Decision flowchart showing the correct IPPA sequence based on body region being examined. The critical distinction between abdominal examination (IAAP) and all other regions (IPPA) to avoid altering bowel sounds.
Health Assessment Data Collection Hierarchy
Comprehensive mind map showing the complete hierarchy of health assessment, from assessment types and data classification through interview phases and physical examination components, with emphasis on the nursing process foundation.
Vital Signs Assessment Pathway
Comprehensive flowchart showing vital sign assessment with normal ranges and immediate recognition of abnormalities, leading to BMI calculation and completion of general survey.
Percussion Sound Distribution by Tissue Density
Pie chart showing the relative frequency and distribution of percussion sounds in clinical practice, with emphasis on resonance as the most common normal finding over lungs.
Complete Health History Component Sequence
Sequential flowchart showing the complete logical order of health history component collection, from initial biographic data through detailed psychosocial assessment, ensuring no critical information is missed.
Palpation Depth Progression
State diagram showing the required progression of palpation from light to deep assessment, with emphasis on performing light palpation first and saving tender areas for last to obtain accurate findings.