Western Mindanao State University

College of Nursing
Zamboanga City

Name of Student: __________________________

Section: ________________________________

PERFORMANCE EVALUATION CHECKLIST ON THE

GENERAL SURVEY, MEASUREMENT, AND VITAL SIGNS OF AN ADULT CLIENT

Objective: Demonstrate the correct procedures in the general survey, measurement, and vital signs of an adult
client.

Procedures Performed Comments

PREPARATION Yes No
1. Gather equipment needed for the examination:
 Weighing scale
 Measurement tape for height
 Sphygmomanometer
 Stethoscope
 Thermometer
 Cotton balls with alcohol
PROCEDURE
2. Introduce yourself and verify the client's identity. Explain to the client what you are
going to do, why it is necessary, and how the client can cooperate.
3. Perform hand hygiene, and observe other appropriate infection control
procedures.
4. Provide for client's privacy.
Note relevant general observation (both normal findings and deviations).
5. Observe client's physical appearance, hygiene, posture, and mobility.
6. Observe consciousness level (alertness, orientation and appropriateness), note for
signs of distress in behavior and facial expression.
7. Note for client's appropriate responses to questions; the quality and organization of
speech.
8. Listen for relevance and organization of thoughts.
9. Obtain the client's weight.
10. Measure the client's height.
11. Observe body built (muscle mass and fat distribution)
12. Assist client to assume a sitting position.
Obtain the client's vital signs:
13. Temperature
14. Radial pulse, rate, and rhythm
15. Respirations, rate, and depth
16. Blood pressure (left arm & right arm)
17.Do pain assessment (if needed).
18. Document findings in the client's record.

EQUIVALENT RATING

SCORE RATING
18 1.0
17 1.25
16 1.5
15 1.75
14 2.0
13 2.25
12 2.5
11 2.75
10 3.0
 Western Mindanao State University
College of Nursing
Zamboanga City

Name of Student: __________________________

Section: ________________________________

PERFORMANCE EVALUATION CHECKLIST

ON THE ASSESSMENT OF SKIN, HAIR, AND NAILS

Objective: Demonstrate the correct procedures in assessing the skin, hair, and nails of an adult client.
Methods: Inspection and Palpation

Procedures Performed Comments

PREPARATION Yes No
1. Gather equipment needed for the examination:
 Clean gloves
 Marker
 Penlight
 Magnifying glass
 Ruler (millimeter)
PROCEDURE
2. Introduce yourself and verify the client's identity. Explain to the client what
you are going to do, why it is necessary, and how the client can cooperate.
3. Perform hand hygiene, and observe other appropriate infection control
procedures.
4. Provide for client's privacy.
5. Ask the client to sit and change position as needed.
6. Ask the client any history of the following:
 Changes in moles or other lesions
 Nonhealing sore or chronic ulceration
 Pruritus or itching
 Rashes
 Changes in skin, hair, or nails
 Food, drug, or environmental allergies
 Medical problems and medications
ASSESSING THE SKIN
7. Inspect the skin for color, odor, and integrity.
8. Inspect, palpate, and describe skin lesions (note the size, color, texture, shape,
and distribution). Use gloves if lesions are open or draining.
9. Observe and palpate skin moisture and temperature (Compare the two feet and
two hands of your client by using dorsal side of your hand).
10. Note skin turgor and elasticity by pinching the skin on an extremity. (Note: Skin
turgor is usually not examined among elderly because their skin is normally
wrinkled).
ASSESSING THE HAIR
11. Ask client the following:
 Recent use of hair dyes, curling, or straightening preparations.
 Recent chemotherapy
 Presence of disease
12. Inspect the hair for evenness of growth over the scalp, and for thickness or
thinness; texture and oiliness.
13. Note presence of infections or infestations by parting the hair in several areas
and checking behind the ears and along the hairline at the neck.
14. Inspect the amount of body hair.
ASSESSING THE NAILS
15. Ask the client any history of the following:
 Diabetes mellitus
 Peripheral circulatory disease
 Previous injury or severe illness
16. Inspect fingernails and toenails for grooming and cleanliness, color, condition,
and angle of attachment.
17. Inspect tissues surrounding nails.
18. Perform blanch test of capillary refill by pressing two or more nails between
your thumb and index fingers (Look for blanching and return of pink color to nail
bed).
19. Discard used gloves properly and perform hand hygiene.
20. Document findings in the client record.

Equivalent Rating
SCORE RATING
20 1.0
19 1.25
18 1.5
17 1.75
16 2.0
15 2.25
14 2.5
13 2.75
12 3.0
 Western Mindanao State University
College of Nursing
Zamboanga City

Name of Student: __________________________

Section: ________________________________

PERFORMANCE EVALUATION CHECKLIST ON THE

ASSESSMENT OF HEAD, FACE, EYES, EARS, NOSE, MOUTH, THROAT, AND NECK

Objective: Demonstrate the correct procedures in assessing the head, face, eyes, ears, nose, mouth, throat, and
neck of an adult client.
Methods: Inspection, Palpation, and Auscultation

Procedures Performed Comments

PREPARATION Yes No
1. Gather equipment needed for the examination:
- Clean gloves - Stethoscope
- Penlight - Cup of water
- Tongue blade/depressor - 2 x 2 gauze pads
- Cotton-tipped applicator - Otoscope
- Snellen's chart - Index card
- Color vision chart - magazine or newspaper
PROCEDURE
2. Introduce yourself and verify the client's identity. Explain to the client
what you are going to do, why it is necessary, and how the client can
cooperate.
3. Perform hand hygiene, and observe other appropriate infection control
Procedures (wear gloves as needed)
4. Provide for client's privacy.
5. Position the client comfortably – seated, if possible.
ASSESSING THE HEAD AND FACE
6. Ask the client any history of the following:
 Headaches
 Jaw tightness or pain
 Food, drug, or environmental allergies
7. Inspect the skull for size, shape, and symmetry.
8. Palpate the skull for nodules or masses and depressions (Use a gentle rotating
motion with the fingertips. Begin at the front and palpate down the midline, then
palpate each side of the head).
9. Inspect facial appearance, symmetry of facial features, lesions, and facial
movements (Ask the client to elevate the eyebrows, frown, or lower the eyebrows,
close the eyes tightly, puff the cheeks, and smile and show teeth).
10. Palpate the temporo-mandibular joint (TMJ) for range of motion and crepitation
(place index finger over it and ask client to open mouth); and sinuses for masses
and tenderness.
ASSESSING THE EYES
11. Ask the client the following:
 Any eye problems or vision problems
 Use of eyeglasses or corrective lenses
 Previous eye surgery, injury, or eye infections
 History of diabetes or hypertension
12. Inspect the eyebrows and eyelashes for evenness of distribution and alignment.
13. Inspect the conjunctiva, sclera, and iris for color.
14. Inspect the pupils for color, shape, symmetry of size. Assess each pupil's
reaction to light (Ask the client to look ahead. Using a penlight and approaching from
a side, shine a light on the pupil. Observe the response. Then, do the same to the
other pupil).
15. Assess near vision by providing adequate lighting and asking the client to read
from a magazine or newspaper.
16. Assess distance vision by asking the client to sit or stand 6 meters (20 ft.) from
Snellen's chart, cover the eye not being tested, and identify the letters or characters.
Take three readings: right eye, left eye, both eyes.
ASSESSING THE EARS
17. Ask the client any history of the following:
 Hearing loss, vertigo, tinnitus, and earache.
 Any discharges or allergies
 Use of hearing device
18. Inspect the auricle for color, symmetry of size, and position. To inspect position,
note the level at which the superior aspect of the auricle attaches to the head with
relation to the eye.
19. Palpate the auricles for texture, elasticity, and areas of tenderness (Gently pull
the auricle upward, downward, and backward. Fold the pinna forward. Push on the
tragus. Apply pressure to the mastoid process, note for tenderness
20. With an otoscope, Inspect the ear canal and tympanic membrane for color,
position, and integrity (Tip the client's head away from you and straighten the ear
canal).
21. Assess the client's response to normal voice tones. If the client has difficulty
hearing, proceed with the following tests: Watch tick test, Tuning fork tests, and
Rinne test.
ASSESSING THE NOSE
22. Ask the client any history of the following:
 Nasal congestion, nosebleed
 Any changes in sense of smell
23. Inspect the external nose for any deviations in shape and size; nasal flaring; any
discharges.
24. Lightly palpate the external nose to determine any areas of tenderness, masses,
or displacements of bone and cartilage.
25. Determine patency of both nasal cavities (Ask the client to close the mouth, and
one naris, and breath through the opposite naris. Repeat the procedure to assess
patency of the other naris) .
26. Tip the client's head back.
27. Inspect the lining of the nasal cavity and the integrity and position of the nasal
septum by using a penlight. Observe for presence of redness, swelling, and growths.
ASSESSING THE MOUTH AND THROAT
28. Ask the client any history of the following:
 Mouth and dental pain
 Sore throat or hoarseness of voice
 Food, drug, or environmental allergies
29. Inspect the outer lips for symmetry of contour, color, and texture (Ask the client
to purse lips as if to whistle).
30. Inspect and palpate the inner lips and buccal mucosa for color, moisture, texture
and the presence of lesions.
31. Inspect the teeth and gums while examining the inner lips and buccal mucosa
(Ask client to remove complete or partial dentures).
32. Inspect the surface of the tongue for position, color, texture, and movement (Ask
the client to protrude tongue and to move it upward and from side to side).
33. Ask the client to open mouth wide and tilt head backward. Then, depress tongue
with a tongue blade as necessary, and use a penlight for appropriate visualization.
34. Inspect the uvula for position and mobility; inspect the tonsils for color,
discharge, and size (Ask the client to say, “ah” so that the soft palate rises).
35. Elicit the gag reflex by pressing the posterior tongue with the tongue blade.
ASSESSING THE NECK
36. Ask the client any history of the following:
 Neck pain or stiffness
 Any problems with neck lumps
 Any diagnoses of thyroid problems, surgery, or radiation
37. In a neutral position, inspect the neck muscles for lumps or masses.
38. Ask the client to do the range-of-motion (ROM) to determine the functions of the
neck muscles.
39. Assess the strength of the neck muscles (Ask the client to turn head to one side
against the resistance of your hand. Repeat with the other side. Then, ask the client
to shrug shoulders against the resistance of your hands).
40. Palpate the entire neck for enlarged lymph nodes.
41. Inspect the thyroid gland for symmetry and visible masses (Ask client to
hyperextend head and swallow. If necessary, offer a glass of water to make it easier
for the client to swallow).
42. Step behind the client. then palpate the thyroid gland for enlargement, masses or
nodules.
43. If enlargement is suspected, auscultate over the thyroid area for a bruit (Use the
bell-shaped diaphragm of the stethoscope).
44. In a semi-Fowler's position, inspect the jugular veins for distention.
45. Discard used gloves, tongue blade, cotton-tip applicator, and gauze properly and
perform hand hygiene.
46. Document findings in the client record.

EQUIVALENT RATING
SCORE RATING
44-46 1.0
42-43 1.25
40-41 1.5
38-39 1.75
36-37 2.0
34-35 2.25
32-33 2.5
30-31 2.75
26-29 3.0
 Western Mindanao State University
College of Nursing
Zamboanga City

Name of Student: __________________________

Section: ________________________________

PERFORMANCE EVALUATION CHECKLIST ON THE

ASSESSMENT OF THORAX, LUNGS, BREASTS, HEART, AND ABDOMEN

Objective: Demonstrate the correct procedures in assessing the thorax, lungs, breasts, and abdomen of an adult
client.
Methods: Inspection, Palpation, Percussion, and Auscultation

Procedures Performed Comments

PREPARATION Yes No
1. Gather equipment needed for the examination:
- Stethoscope -Tape measure
- Water soluble marker - gown and drape
- Ruler with centimeter - gloves
PROCEDURE
2. Introduce yourself and verify the client's identity. Explain to the client
what you are going to do, why it is necessary, and how the client can
cooperate.
3. Perform hand hygiene, and observe other appropriate infection control
procedures.
4. Provide for client's privacy. Ask client to wear gown.
5. Position the client comfortably – seated, if possible.
6. Ask the client any history of the following:
 Allergies, wheezing, swelling, coughs, pain
 History of illness, including cancer
 Smoking and occupational hazards
 Any medications being taken
ASSESSING THE POSTERIOR THORAX
7. Inspect the shape and symmetry of the thorax from posterior and lateral views.
Compare the anteroposterior diameter to the transverse diameter.
8. Inspect the spinal alignment for deformities (Have the client stand. From a lateral
position, observe the three normal curvatures: cervical, thoracic, and lumbar).
Observe position of scapulae.
9. Assess for lateral deviation of the spine (scoliosis), observe the standing client
from the rear. Have the client bend forward at the waist, and observe from behind.
10. Assess for chest excursion. Place the palms of both your hands over the lower
thorax, with your thumbs, adjacent to the spine and your fingers stretched laterally
(like a butterfly). Ask the client to take a deep breath while you feel and observe for
the equal expansion of the chest. Note for use of accessory muscles.
11. Palpate the posterior chest for vocal (tactile) fremitus.
12. Place the palmar surfaces of your fingertips or the ulnar aspect of your hand or
closed fist on the posterior chest, starting near the apex moving to the base of the
lungs while asking the client to repeat such words as “blue moon” or “99”. Note level
where fremitus is palpable, increased, diminished, or absent.
13. Percuss the thorax using the percussion sequence.
14. Auscultate the posterior chest using the flat-disc diaphragm of the stethoscope
(Use the systematic procedure used in percussion).
ASSESSING THE ANTERIOR THORAX
15. Inspect breathing patterns.
16. Inspect the costal angle and the angle at which the ribs enter the spine.
17. Palpate the anterior chest for respiratory excursion and tactile fremitus in the
same manner as for the posterior chest (Omit this examination for clients with large
breasts).
18. Percuss the anterior chest systematically. Begin above the clavicles in the
supraclavicular space, and proceed downward to the diaphragm. Displace female
breasts for proper examination.
19. Auscultate the trachea for bronchial sounds then proceed to auscultate the
anterior chest (Use the sequence used in percussion, beginning over the brochi
between the sternum and the clavicles).
ASSESSING THE FEMALE BREASTS
20. Ask client any history of the following:
 Any pain or tenderness (with or without menses), lump or masses
 Any nipple discharge
 Breast cancer in the family
 Any change in size, shape, or contour
21. In a sitting position with hands on hips, inspect the breasts for size, symmetry,
and contour.
22. Inspect the areola and nipples for size, shape, color, lesions, swelling, or
discharges. Note for any dimpling of the skin of the breasts.
23. Palpate the subclavicular, and supraclavicular lymph nodes.
24. In a supine position with arm over head and small pillow under shoulder of
breast being examined, palpate the breast in a circular fashion starting from the
outermost area until the nipple area. Note any tenderness and discharges from
nipples.
25. Wear gloves if open lesions or discharge present.
26. Compress each nipple to determine the presence of any discharges. Assess the
amount, color, consistency, and odor.
27. Palpate the axillary lymph nodes.
28. Teach client the breast self-examination (BSE).
ASSESSING THE MALE BREASTS
29. Inspect the breast for size, symmetry, and contour. Note for any skin
discoloration and lesions.
30. Palpate the subclavicular, supraclavicular, and axillary lymph nodes.
ASSESSING THE HEART
31. Ask client any history of the following:
 Chest pain, palpitations
 Edema, dyspnea, and cough
 Family history of hypertension, stroke, congenital heart disease
32. Place client in either supine or sitting position then inspect and palpate the apical
area for pulsation, noting its specific location.
33. Inspect and palpate the epigastric area at the base of the sternum for abdominal
aortic pulsations.
34. Auscultate the heart in all four anatomic sites: aortic, pulmonic, tricuspid, and
apical (mitral). Note apical rate and rhythm.
ASSESSING THE ABDOMEN (Inspection, Auscultation, Percussion, Palpation)
35. Ask the client for any of the following:
 Incidence of abdominal pain
 Change in appetite and food intolerances
 Bowel habits and problems with bowel movement
 Food ingested in the last 24 hours.
36. Have client empty bladder.
37. Position client supine; knees slightly flexed to relax the abdomen.
38. Inspect the abdomen for size, shape, symmetry, surface characteristics such as
color, lesions, striae.
39. Inspect umbilicus for position, contour, color, and discharge. Note any bulges
(hernias) by asking the client to raise head from the bed.
40. Auscultate the abdomen in all four quadrants for at least 5 minutes using the
diaphragm portion of the stethoscope.
41. Use the bell portion of the stethoscope to listen for vascular sounds (bruits or
venous hums).
42. Percuss the abdomen in all four quadrants; percuss tender areas last. Note
areas of dullness and tympany.
43. Lightly palpate each quadrant; palpating painful areas last. Note surface
characteristics and areas of tenderness. Perform test for rebound tenderness
(McBurney's point) if client has complaint of abdominal pain.
44. Wash hands after the procedure.
45. Document findings in the client’s record.

EQUIVALENT RATING
SCORE RATING
43-45 1.0
40-42 1.25
38-39 1.5
36-37 1.75
34-35 2.0
31-33 2.25
29-30 2.5
27-28 2.75
25-26 3.0
 Western Mindanao State University
College of Nursing
Zamboanga City

Name of Student: __________________________

Section: ________________________________

PERFORMANCE EVALUATION CHECKLIST ON THE

ASSESSMENT OF FEMALE OR MALE GENITALIA, RECTUM, AND ANUS

Objective: Demonstrate the correct procedures in assessing the female or male genitalia, rectum, and anus of an
adult client.
Methods: Inspection and Palpation

Procedures Performed Comments

PREPARATION Yes No
1. Gather equipment needed for the examination:
- Clean gloves
- Drape
- Supplemental lighting (if needed)
- Water-soluble lubricant
PROCEDURE
2. Introduce yourself and verify the client's identity. Explain to the client
what you are going to do, why it is necessary, and how the client can
cooperate.
3. Perform hand hygiene, use gloves, and observe other appropriate infection
control procedures.
4. Provide for client's privacy. Request the presence of another woman/person, if
desired, required by agency policy or requested by client.
5. Drape client appropriately or cover the pelvic area with a drape at all times when
not actually being examined.
6. Ask the client any history of the following:
 Menarche, LMP, regularity of menstrual cycle, duration and amount of daily
flow, or presence of pain (for female clients).
 Labor and delivery complications (for female clients)
 Painful intercourse, urination, or incontinence
 Urgency or frequency of urination at night.
 History of sexually transmitted diseases, past and present
 Hernias and prostate problems (for males).
ASSESSING THE FEMALE GENITALIA
7. Position client in supine, with feet elevated on the stirrups of an examination
table.
8. Inspect the distribution, amount, and characteristics of the pubic hair.
9. Inspect the skin of the pubic area for parasites, inflammation, swelling, and
lesions. To assess pubic skin adequately, separate the labia majora and labia
minora.
10. Inspect the clitoris, urethral orifice, and vaginal orifice when separating the labia
minora.
11. Palpate the inguinal lymph nodes.
ASSESSING THE MALE GENITALIA
12. Cover the pelvic area with a drape at all times when not actually being
examined.
13. Inspect the distribution, amount, and characteristics of the pubic hair.
14. Inspect the penile shaft and glans penis for lesions, nodules, swellings, and
inflammation.
15. Inspect the urethral meatus for swelling, inflammation, and discharge.

16. Palpate the penis for tenderness, thickening, and nodules. Use your thumb and
first two fingers.
17. Inspect the scrotum for appearance, general size, and symmetry. To facilitate
inspection of the scrotum, ask the client to hold his penis out of the way.
18. Palpate the scrotum to assess the status of underlying testes, epididymis, and
spermatic cord. Palpate both testes simultaneously for comparative purposes.
19. Inspect both inguinal areas for bulges while the client is standing, if possible.
20. Palpate for hernias.
ASSESSING THE RECTUM AND ANUS
21. Because digital examinations can cause apprehension and embarassment in the
client, it is important to help the client relax by encouraging the client to take deep
breaths and informing the client about potential sensations such as feelings of
defecation or passing gas.
22. Ask client any history of the following:
 Bright blood in stools, tarry black stools, diarrhrea, constipation, abdominal
pain, excessive gas, hemorrhoids, or rectal pain.
 Family history of colorectal cancer.
23. In adults, a left lateral or Sim's position with the upper leg acutely flexed is
required for the examination.
For females: A dorsal recumbent position with hips externally rotated and knees
flexed or a lithotomy position may be used.
For males: A standing position while the client bends over the examining table may
also be used.
24. Inspect the anus or surrounding tissue for color, integrity, and skin lesions.
25. Palpate the rectum for anal sphincter tonicity, nodules, masses, and tenderness.
26. On withdrawing the finger from the rectum and anus, observe it for feces, If
ordered, perform a test for occult blood on the stool.
27. Discard used gloves and perform hand hygiene.
28. Document findings in the client’s record.

EQUIVALENT RATING
SCORE RATING
28 1.0
26-27 1.25
24-25 1.5
22-23 1.75
20-21 2.0
18-19 2.25
17 2.5
16 2.75
15 3.0
 Western Mindanao State University
College of Nursing
Zamboanga City

Name of Student: __________________________

Section: ________________________________

PERFORMANCE EVALUATION CHECKLIST ON THE

ASSESSMENT OF THE MUSCULOSKELETAL SYSTEM AND THE DEEP TENDON REFLEXES

Objective: Demonstrate the correct procedures in assessing the musculoskeletal system and deep tendon
reflexes of an adult client.
Methods: Inspection and Palpation

Procedures Performed Comments

PREPARATION Yes No
1. Gather equipment needed for the examination:
- Percussion hammer
- tape measure
PROCEDURE
2. Introduce yourself and verify the client's identity. Explain to the client
what you are going to do, why it is necessary, and how the client can
cooperate.
3. Perform hand hygiene, use gloves, and observe other appropriate infection
control procedures.
4. Observe gait for base, weight-bearing stability, feet position, stride, arm swing and
posture
5. Inspect and palpate cervical, thoracic and lumbar spine for pain and tenderness.
6. Test ROM (Range of Motion) of cervical spine
7. Test ROM of thoracic and lumbar spine.
8. Inspect and palpate shoulders for symmetry, color, swelling and masses
9. Test ROM of shoulders
10. Inspect and palpate elbows for size, shape, deformities, redness or swelling
11. Test ROM of elbows.
12. Inspect and palpate wrists for size, shape, symmetry, color, swelling, tenderness
and nodules
13. Test ROM of wrists
14. Test for carpal Tunnel syndrome through Phalen’s test
15. Inspect and palpate hands and fingers for size, shape, symmetry, swelling,
colour, tenderness and nodules
16. Test ROM of hands and fingers
17. Inspect and palpate hips for shape and symmetry
18. Test ROM of hips
19. Inspect and palpate knees for size, shape, symmetry, deformities, swelling, pain
and alignment
20. Test for ROM of knees
21. Inspect and palpate ankles and feet for position, alignment, shape, tenderness,
temperature, swelling and nodules.
22. Test ROM of ankles and toes
23. Test deep tendon reflexes
 Biceps
 Brachioradialis
 Triceps
 Patellar
 Achilles
 Ankle clonus

24. Wash hands after the procedure.

25. Document findings in the client’s record.

EQUIVALENT RATING
SCORE RATING
24-25 1.0
23 1.25
22 1.5
20-21 1.75
19 2.0
18 2.25
17 2.5
16 2.75
15 3.0