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Purdue University Globle
NU552 Advanced Health Assessment Course Module Overview
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A head-to-toe physical assessment is a systematic examination used to evaluate a patient’s overall health, identify abnormal findings, and recognize potential problems early. For NU552 clinical assessments, students should understand both the correct examination sequence and the purpose of each assessment technique. The process generally begins with the general survey and vital signs and then moves through the skin, HEENT, neurological system, neck, thorax, cardiovascular system, abdomen, peripheral vascular system, extremities, and other focused areas as clinically indicated.
The general survey establishes the first overall impression of the patient. Before beginning a detailed physical examination, the healthcare provider observes the patient’s appearance, behavior, posture, mobility, hygiene, nutritional status, and apparent level of distress.
Baseline measurements and observations commonly include:
Temperature
Heart rate and respiratory rate
Blood pressure
Oxygen saturation
Pain assessment
Height and weight
Level of consciousness
Orientation and general behavior
Skin color and hydration
Mobility and apparent physical condition
The general survey is important because it can reveal urgent concerns before the more detailed examination begins. A patient who appears acutely ill, confused, cyanotic, severely short of breath, or hemodynamically unstable may require immediate attention.
A complete skin assessment evaluates the integumentary system and can provide clues about hydration, circulation, infection, nutritional status, and systemic disease.
Inspect and palpate the skin for:
Color and pigmentation
Temperature
Moisture
Texture and thickness
Skin turgor
Lesions or rashes
Bruising and scars
Wounds or pressure injuries
Hair distribution
Nail appearance
Capillary refill
Findings should be compared between corresponding areas of the body when appropriate. Changes such as pallor, cyanosis, excessive dryness, edema, abnormal pigmentation, or delayed capillary refill may require additional assessment.
The HEENT assessment examines the head, eyes, ears, nose, and throat. It evaluates sensory function, facial structures, oral health, and findings that may contribute to neurological or systemic assessment.
Inspect and palpate the scalp and skull for tenderness, masses, lesions, deformities, or other abnormalities. Facial symmetry should also be observed because asymmetry may be associated with neurological or musculoskeletal problems.
The eye examination may include assessment of:
Visual acuity
Pupil size and equality
Pupillary reaction to light
Accommodation
Extraocular movements
Visual fields
Conjunctiva
Sclera
Eyelids and surrounding structures
Pupil size, reactivity, and eye movement are particularly important components of a neurological assessment.
Inspect the external ears for lesions, drainage, swelling, or structural abnormalities. Hearing can be assessed through conversational speech and appropriate bedside hearing tests. The ear canal and tympanic membrane can be examined when clinically indicated.
Inspect the nose and nasal passages for obstruction, inflammation, drainage, bleeding, or structural abnormalities. The frontal and maxillary sinus areas may be palpated or percussed for tenderness when sinus disease is suspected.
The oral examination includes assessment of the:
Lips
Oral mucosa
Teeth and gums
Tongue
Hard and soft palate
Tonsils
Pharynx
The examiner should note oral moisture, lesions, inflammation, discoloration, dental problems, and other abnormalities. Oral findings can provide clues about infection, dehydration, nutritional deficiencies, and systemic disease.
Cranial nerve testing evaluates sensory and motor functions associated with the twelve cranial nerves. The extent of testing depends on the patient’s condition and the purpose of the examination.
CN I is associated with the sense of smell. When clinically appropriate, the patient may be asked to identify a familiar odor presented separately to each nostril.
CN II contributes to vision. Assessment can include:
Visual acuity
Visual fields
Pupillary responses to light
The oculomotor, trochlear, and abducens nerves control most extraocular movements. Assess the patient’s ability to follow a target through the six cardinal fields of gaze while observing for restricted movement, diplopia, or nystagmus.
The trigeminal nerve contributes to facial sensation and mastication. Assessment may include facial sensation and strength of the muscles used for chewing. The corneal reflex may be tested when clinically indicated.
Assess facial motor function by asking the patient to perform movements such as:
Smiling
Raising the eyebrows
Frowning
Closing the eyes tightly
Puffing out the cheeks
Observe for asymmetry or weakness.
CN VIII is associated with hearing and vestibular function. Hearing may be assessed through conversational speech or bedside hearing tests. Balance and vestibular function can be evaluated when clinically appropriate.
Assessment may include voice quality, swallowing, and movement of the soft palate. The gag reflex is not routinely required in every examination and should be assessed when clinically indicated.
Assess the strength of the trapezius and sternocleidomastoid muscles by asking the patient to shrug the shoulders and turn the head against resistance.
Ask the patient to protrude the tongue. Assess tongue symmetry, movement, strength, and possible deviation or muscle wasting.
The neck examination evaluates lymph nodes, the thyroid gland, tracheal alignment, vascular structures, and range of motion.
Important findings include:
Cervical lymph node enlargement
Tracheal position
Thyroid size and consistency
Neck mobility
Neck masses or tenderness
Enlarged or tender lymph nodes may occur with infection or inflammation, while thyroid enlargement or nodules may require further endocrine evaluation.
The posterior thorax is generally assessed with the patient sitting upright when possible. Observe the chest for symmetry, spinal alignment, respiratory effort, and expansion.
Use the four major physical examination techniques:
Inspection
Palpation
Percussion
Auscultation
Listen systematically over the posterior lung fields and compare corresponding areas bilaterally. Breath sounds should be evaluated for their quality, intensity, and distribution. Crackles, wheezes, rhonchi, diminished breath sounds, or asymmetry may indicate an abnormal respiratory finding requiring further evaluation.
Assessment of the upper extremities combines musculoskeletal, neurological, and vascular observations.
Evaluate:
Muscle strength
Range of motion
Sensation
Deep tendon reflexes when indicated
Skin temperature and color
Peripheral circulation
Swelling or edema
Always compare the right and left sides when appropriate. Differences in strength, sensation, movement, or circulation can provide important clinical information.
The anterior chest examination evaluates respiratory and cardiovascular function. Depending on the patient’s condition, the assessment may be performed with the patient sitting, supine, or in another appropriate position.
The cardiovascular and respiratory examination may include:
Inspection of chest movement
Palpation
Percussion when indicated
Lung auscultation
Cardiac auscultation
Assessment of the apical impulse
Evaluation of jugular venous pressure
Carotid pulse assessment
Carotid auscultation for bruits when appropriate
Heart sounds should be assessed systematically at the appropriate auscultation sites. Abnormal sounds, rhythm irregularities, or other concerning findings may warrant additional cardiovascular assessment.
The abdominal examination follows a different sequence from most body systems because palpation and percussion can influence bowel activity.
The standard sequence is:
Inspection
Auscultation
Percussion
Palpation
During inspection, assess abdominal contour, symmetry, skin changes, scars, distention, and visible masses. Auscultation is performed before percussion and palpation to avoid altering bowel sounds.
The examiner may assess:
Bowel sounds
Abdominal tenderness
Masses
Organ enlargement
Abdominal distention
Fluid accumulation
Guarding or rigidity
The depth and extent of palpation depend on the patient’s symptoms and clinical situation.
The peripheral vascular examination evaluates circulation to the extremities and helps identify possible arterial or venous abnormalities.
Assess:
Femoral pulses
Popliteal pulses
Posterior tibial pulses
Dorsalis pedis pulses
Skin temperature
Skin color
Peripheral edema
Symmetry of pulses
Relevant lymph nodes
Weak or absent pulses, unilateral swelling, temperature changes, skin discoloration, or other vascular findings should be documented and evaluated in context.
The lower extremity examination assesses neurological, musculoskeletal, and vascular function.
Assessment may include:
Muscle strength
Range of motion
Sensory function
Deep tendon reflexes
Plantar response
Peripheral pulses
Edema
Gait-related function
The Babinski or plantar response may be assessed as part of a neurological examination when clinically indicated. Other special tests should be selected based on the patient’s symptoms and suspected condition rather than performed automatically on every patient.
The standing portion of the physical examination allows the examiner to evaluate posture, alignment, gait, balance, and weight-bearing.
Observe:
Spinal alignment
Posture
Gait
Balance
Coordination
Weight distribution
Ability to stand and move safely
An abnormal gait can be associated with neurological, musculoskeletal, vestibular, or other functional problems. Any abnormality should be interpreted together with the patient’s history and other examination findings.
Genital and rectal examinations are performed when clinically indicated, with attention to privacy, informed consent, patient comfort, and appropriate chaperone policies.
Depending on the patient’s symptoms and clinical needs, assessment may involve inspection of the external genitalia, examination of the anal region, or a focused internal examination. A prostate examination may be performed in appropriate patients when indicated.
These examinations are not necessarily part of every routine head-to-toe assessment. They should be guided by symptoms, screening recommendations, patient history, and clinical judgment.
A commonly used head-to-toe sequence is:
General survey and vital signs
Skin
HEENT
Cranial nerves and neurological findings
Neck
Posterior thorax and lungs
Upper extremities
Anterior chest, heart, and lungs
Abdomen
Peripheral vascular system
Lower extremities
Standing assessment
Genital and rectal examination when clinically indicated
The exact sequence can vary depending on the patient’s condition, the healthcare setting, and the purpose of the examination. A systematic approach, however, helps clinicians remain organized and reduces the risk of missing important findings.
A structured physical examination promotes consistency and makes it easier to compare findings over time. It also helps healthcare professionals communicate clinical information clearly and recognize changes in a patient’s condition.
For nursing students, learning the sequence is only part of effective clinical assessment. Students should also understand what constitutes a normal finding, what may indicate an abnormality, how to document findings, and when an abnormal finding requires further assessment or intervention.
A head-to-toe assessment generally includes the general survey and vital signs followed by assessment of the skin, HEENT structures, neurological function, neck, lungs, heart, abdomen, peripheral vascular system, and extremities. Additional examinations, such as genital or rectal assessment, are performed when clinically indicated.
The standard abdominal assessment sequence is inspection, auscultation, percussion, and palpation. Auscultation is performed before percussion and palpation because physical manipulation of the abdomen can alter bowel sounds.
Cranial nerve assessment helps evaluate neurological function involving sensory and motor pathways. It can provide information about vision, eye movement, facial sensation, facial movement, hearing, swallowing, shoulder movement, and tongue function.
Jugular venous pressure provides information about right-sided cardiac filling pressure and venous volume status. An elevated JVP can occur with conditions associated with increased right-sided pressures, including some forms of heart failure.
Bilateral comparison helps identify asymmetry in strength, sensation, pulses, movement, temperature, swelling, or other findings. Comparing corresponding areas can make subtle abnormalities easier to recognize.
Students should focus on a consistent assessment sequence while also understanding the purpose of each examination technique. Important skills include recognizing normal versus abnormal findings, documenting accurately, maintaining patient privacy and safety, and reporting significant abnormalities promptly.
A head-to-toe physical assessment is more than a checklist of body parts. It is a structured clinical process that combines observation, inspection, palpation, percussion, auscultation, neurological testing, and focused assessments to develop an overall picture of the patient’s health. For NU552 exam preparation, students should know the major assessment sequence, the purpose of each component, the correct abdominal examination order, and the clinical significance of common abnormal findings.
Bickley, L. S. (2024). Bates’ guide to physical examination and history taking (14th ed.). Wolters Kluwer. https://shop.lww.com/Bates-Guide-to-Physical-Examination-and-History-Taking/p/9781975210879
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2022). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). Elsevier. https://www.elsevier.com/books/seidels-guide-to-physical-examination/ball/9780323763051
Jarvis, C., & Eckhardt, A. (2023). Physical examination and health assessment (9th ed.). Elsevier. https://www.elsevier.com/books/physical-examination-and-health-assessment/jarvis/9780323809846
Hinkle, J. L., & Cheever, K. H. (2021). Brunner & Suddarth’s textbook of medical-surgical nursing (15th ed.). Wolters Kluwer. https://shop.lww.com/Brunner—Suddarth-s-Textbook-of-Medical-Surgical-Nursing/p/9781975161034
