General Assessment
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Height
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Weight
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Pulse (60-100)
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Respirations (12-20)
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Temperature (97.8-99.1)
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Blood Pressure (120-139/80-89)
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Pain (scale of 0-10)
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Inspect: color, moisture, hair, rashes, lesions, pallor, edema
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Palpate: temperature, turgor, lesions, edema, texture
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Inspect: shape, symmetry
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Palpate: tenderness, deformity
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Inspect: shape, color
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Capillary refill (< 3 sec)
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Inspect: symmetry, shape, size, uniformity
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Inspect: symmetry, lesions, scars
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Palpate: tenderness, lymph nodes, thyroid gland, TMG
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Inspect: interior and exterior, visual fields, acuity, reflexes
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Inspect: color, shape, symmetry, interior inspection
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Palpate: tenderness, deformity
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Inspect: shape, symmetry, interior inspection
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Palpate: frontal sinus, maxillary sinuses
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Inspect: interior and exterior
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Inspection: respiration quality, symmetry, deformity, tracheal location
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Palpation: tenderness, fremitus, chest expansion
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Percussion: percussive tones, diaphragmatic excursion
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Auscultation: breath sounds and quality
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Inspection: jugular venous pulse
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Palpate: pulses, PMI
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Auscultate: heart sounds (S1, S2)
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Inspect: color, edema
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Palpate: temperature, edema
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Inspect: discomfort, uniformity, color, symmetry, scars, hernia, peristalsis, pulsations
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Auscultate: bowel sounds, bruits
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Percussion: four quadrants, liver, spleen, renal tenderness
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Palpation: light to deep, liver, spleen, aorta, rebound tenderness, fluid wave
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Inspection: asymmetry, deformity, atrophy
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Palpation: major joints, tenderness, deformity, ROM
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Inspect: mental status, cranial nerves, coordination, movement, senses
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Palpate: motor strength, muscle tone, reflexes, senses
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Inspect: general appearance, lesions, scars
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Palpate: breast exam, testicular exam, prostate exam, vaginal exam, pap smear
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Palpate: assess lymph node locations
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Cheatography n. The art of mapping complex subjects into clear, instantly navigable reference guides.
