,Disclaimer
Medicine and nursing are continuously changing practices. The author and publisher have
reviewed all information in this book with resources believed to be reliable and accurate and have
made every effort to provide information that is up to date with best practices at the time of
publication. Despite our best efforts we cannot disregard the possibility of human error and
continual changes in best practices the author, publisher, and any other party involved in the
production of this work can warrant that the information contained herein is complete or fully
accurate. The author, publisher, and all other parties involved in this work disclaim all
responsibility from any errors contained within this work and from the results from the use of this
information. Readers are encouraged to check all information in this book with institutional
guidelines, other sources, and up to date information. For up to date disclaimer information
please visit: http://www.nrsng.com/about.
NCLEX®, NCLEX®-RN ®are registered trademarks of the National Council of State Boards of
Nursing, INC. and hold no affiliation or support of this product.
All Rights Reserved. No part of this publication may be reproduced in any form or by any means,
including scanning, photocopying, or otherwise without prior written permission of the copyright
holder. This book is intended for entertainment purposes only and does not imply legal, medical,
financial or other professional advice. The reader should seek the help of a competent professional
for all matters.
Photo Credits:
All photos are original photos taken or created by the author or rights purchased at Fotolia.com. All
rights to appear in this book have been secured. Some image rights were obtained via
ECGpedia.com.
Some images within this book are either royalty-free images, used under license from their respective
copyright holders, or images that are in the public domain. Images used under a creative commons
license are duly attributed, and include a link to the relevant license, as per the author's instructions.
All Creative Commons images used under the following license. All works in the public domain are
considered public domain given life of the author plus 70 years or more as required by United States
law.
,Introduction
This book provides the outline for a basic physical assessment. The head to toe assessment is a
fundamental skill in nursing practice and allows the nurse to quickly identify abnormalities in the
patient.
This is not intended to be a complete guide to pathophysiology but to provide a framework for
completing a thorough head to toe assessment.
Learning to efficiently and quickly complete the exam allows the nurse to understand the patient, their
needs, and concerns, and allows the nurse the ability to provide the best possible care.
This book is structured in the recommended order for completing the head to toe assessment. Each
section contains a short anatomy section followed by an overview of the assessment technique for the
given section. This is followed by a small sample of the abnormal findings the nurse may identify for
that body system.
The final chapter of the book includes videos, charts, graphs, and website resources to help you in
your assessments.
, Table of Contents
Disclaimer
Nursing Assessment
Introduction
Head to Toe Assessment Checklist
Integumentary
Inspection
Palpation
Cyanosis
Rash
Jaundice
Macule, Patch, Papule, Plaque, Vesicles, Bulla, Fissure, Erosion, Ulcer
Scalp
Inspection and Palpation
Nails
Inspection and Palpation
Clubbing
Head
Inspection and Palpation
Neck
Inspection and Palpation
Goiter
Eyes
Inspection
Pinguecula
Xanthelasma
Arcus Senilis
Ptosis
Exopthalmos
Conjunctivitis
Anisocoria
Medicine and nursing are continuously changing practices. The author and publisher have
reviewed all information in this book with resources believed to be reliable and accurate and have
made every effort to provide information that is up to date with best practices at the time of
publication. Despite our best efforts we cannot disregard the possibility of human error and
continual changes in best practices the author, publisher, and any other party involved in the
production of this work can warrant that the information contained herein is complete or fully
accurate. The author, publisher, and all other parties involved in this work disclaim all
responsibility from any errors contained within this work and from the results from the use of this
information. Readers are encouraged to check all information in this book with institutional
guidelines, other sources, and up to date information. For up to date disclaimer information
please visit: http://www.nrsng.com/about.
NCLEX®, NCLEX®-RN ®are registered trademarks of the National Council of State Boards of
Nursing, INC. and hold no affiliation or support of this product.
All Rights Reserved. No part of this publication may be reproduced in any form or by any means,
including scanning, photocopying, or otherwise without prior written permission of the copyright
holder. This book is intended for entertainment purposes only and does not imply legal, medical,
financial or other professional advice. The reader should seek the help of a competent professional
for all matters.
Photo Credits:
All photos are original photos taken or created by the author or rights purchased at Fotolia.com. All
rights to appear in this book have been secured. Some image rights were obtained via
ECGpedia.com.
Some images within this book are either royalty-free images, used under license from their respective
copyright holders, or images that are in the public domain. Images used under a creative commons
license are duly attributed, and include a link to the relevant license, as per the author's instructions.
All Creative Commons images used under the following license. All works in the public domain are
considered public domain given life of the author plus 70 years or more as required by United States
law.
,Introduction
This book provides the outline for a basic physical assessment. The head to toe assessment is a
fundamental skill in nursing practice and allows the nurse to quickly identify abnormalities in the
patient.
This is not intended to be a complete guide to pathophysiology but to provide a framework for
completing a thorough head to toe assessment.
Learning to efficiently and quickly complete the exam allows the nurse to understand the patient, their
needs, and concerns, and allows the nurse the ability to provide the best possible care.
This book is structured in the recommended order for completing the head to toe assessment. Each
section contains a short anatomy section followed by an overview of the assessment technique for the
given section. This is followed by a small sample of the abnormal findings the nurse may identify for
that body system.
The final chapter of the book includes videos, charts, graphs, and website resources to help you in
your assessments.
, Table of Contents
Disclaimer
Nursing Assessment
Introduction
Head to Toe Assessment Checklist
Integumentary
Inspection
Palpation
Cyanosis
Rash
Jaundice
Macule, Patch, Papule, Plaque, Vesicles, Bulla, Fissure, Erosion, Ulcer
Scalp
Inspection and Palpation
Nails
Inspection and Palpation
Clubbing
Head
Inspection and Palpation
Neck
Inspection and Palpation
Goiter
Eyes
Inspection
Pinguecula
Xanthelasma
Arcus Senilis
Ptosis
Exopthalmos
Conjunctivitis
Anisocoria
