Normal Findings List?

[kpmadden83]

Hello,

I'm bridging to my RN and currently taking a class about physical assessments.  We have to write a paper that's a head-to-toe assessment with 8 pages describing the normal assessment findings. Our book lists the ABNORMAL findings, but we're supposed to write what we'd be seeing on a patient who had no health problems, basically listing all the normal findings.

Is there anywhere I can find a list of the normal findings of a head-to-toe physical exam?  I.e. I need to know the physical findings for skin, nails, and hair; then the eyes; then the neck; then the breasts; etc etc.

Hopefully this makes sense, thanks!

[203bravo, MSN, APRN]

I find it hard to believe that any physical assessment text would not give the expected normal findings per system along with the abnormal ones.

You may have to find them chapter by chapter instead of a handy dandy list form that can simply be copied and quoted into a paper.

Best of luck.

[NICU Guy, BSN, RN]

a five second Google search resulted in this website: https://thriveap.com/blog/cheat-sheet-normal-physical-exam-template

[JKL33]

18 hours ago, 203bravo said:

I find it hard to believe that any physical assessment text would not give the expected normal findings per system along with the abnormal ones.

You may have to find them chapter by chapter instead of a handy dandy list form that can simply be copied and quoted into a paper.

Ditto.

I searched yesterday after first reading this post and it's easy to find things to copy down.

To the OP, this is not the way.

Surely your introductory nursing text describe things in such a way that you can understand what things are generally normal findings. This is information that you will want to know; it's foundational.

[kpmadden83]

22 hours ago, 203bravo said:

I find it hard to believe that any physical assessment text would not give the expected normal findings per system along with the abnormal ones.

You may have to find them chapter by chapter instead of a handy dandy list form that can simply be copied and quoted into a paper.

Best of luck.

The book doesn't list normal findings anywhere.  You'd have to go through, not just chapter by chapter, but section by section within the chapter.  For instance, there is a single list of all the systems, but it doesn't have a list of normal findings.  It simply states abnormal things to look for.  For instance, the peripheral vascular section states "coldness, numbness and tingling, swelling of legs (time of day, activity), discoloration in hands and feet (bluish red, pallor, mottling, associated with position, especially around feet and ankles), varicose veins or complications, intermittent claudication, thrombophlebitis, ulcers."

That's a list of abnormal things to look for, not a list of the normal findings.

So you can turn to the peripheral vascular chapter and look for a list of "normal findings" there, but there's not really a list there either. Instead, what you find is twenty pages with half of the page saying "normal findings" and the other half that says "abnormal findings." 

An example of the "normal findings" section I just randomly picked says "The modified Allen test is used to evaluate the adequacy of collateral circulation before cannulating the radial artery. Firmly occlude both the ulnar and radial arteries of one hand while the person makes a fist several times. This causes the hand to blanch. Ask the person to open the hand without hyperextending it; then release pressure on the ulnar artery while maintaining pressure on the radial artery. Adequate circulation is suggested by a palmar blush, a return to the normal color of the hand in less than 7 seconds. Although this test is simple and useful, it is relatively crude and subject to error (I.e., you must occlude both arteries uniformly with 11 pounds of pressure for the test to be accurate."

All of that for "Allen test positive."  And even within that, it's never written as a simple, succinct finding you'd write as a note.  And this goes on for 20 pages for a single system.  There is no list along the lines of "Tendon function is normal. Capillary refill is less than 3 seconds in all extremities. Pulses palpable. Steady gait noted."

 

And this is for a paper that the teacher says is just a requirement and we should really be spending our time focusing on the practicum.  She said they're completely changing the class next year.

 

7 hours ago, NICU Guy said:

a five second Google search resulted in this website: https://thriveap.com/blog/cheat-sheet-normal-physical-exam-template

That's close but not quite in-depth enough.  I think I can start with this and add more detail.

[kpmadden83]

4 hours ago, JKL33 said:

Surely your introductory nursing text describe things in such a way that you can understand what things are generally normal findings. This is information that you will want to know; it's foundational.

I just explained how the book is formatted up above, but it's not written in a clean, succinct way.  And this is for a paper that the teacher says is a requirement that shouldn't be a huge area of focus for our time, that we should be spending every day working on the practicum instead.  She also stated that they're completely changing the class next year.

[JKL33]

33 minutes ago, kpmadden83 said:

And this is for a paper that the teacher says is a requirement that shouldn't be a huge area of focus for our time, that we should be spending every day working on the practicum instead.  She also stated that they're completely changing the class next year.

So frustrating.

If I had a dime for the number of times I've been in classes where we were told this same thing while we're looking at a detailed and rule-happy instructions/rubric or an extensive/labor intensive assignment such as the one you've been given, I'd be rich. I don't mind doing the work at all--but I do mind this round-about way of saying that they aren't going to give it much weight and don't plan to invest too much of their time providing feedback. That's what they mean when they say that WE shouldn't stress out over something.

[toomuchbaloney]

On 11/4/2021 at 6:45 PM, kpmadden83 said:

The book doesn't list normal findings anywhere.  You'd have to go through, not just chapter by chapter, but section by section within the chapter.  For instance, there is a single list of all the systems, but it doesn't have a list of normal findings.  It simply states abnormal things to look for.  For instance, the peripheral vascular section states "coldness, numbness and tingling, swelling of legs (time of day, activity), discoloration in hands and feet (bluish red, pallor, mottling, associated with position, especially around feet and ankles), varicose veins or complications, intermittent claudication, thrombophlebitis, ulcers."

That's a list of abnormal things to look for, not a list of the normal findings.

So you can turn to the peripheral vascular chapter and look for a list of "normal findings" there, but there's not really a list there either. Instead, what you find is twenty pages with half of the page saying "normal findings" and the other half that says "abnormal findings." 

An example of the "normal findings" section I just randomly picked says "The modified Allen test is used to evaluate the adequacy of collateral circulation before cannulating the radial artery. Firmly occlude both the ulnar and radial arteries of one hand while the person makes a fist several times. This causes the hand to blanch. Ask the person to open the hand without hyperextending it; then release pressure on the ulnar artery while maintaining pressure on the radial artery. Adequate circulation is suggested by a palmar blush, a return to the normal color of the hand in less than 7 seconds. Although this test is simple and useful, it is relatively crude and subject to error (I.e., you must occlude both arteries uniformly with 11 pounds of pressure for the test to be accurate."

All of that for "Allen test positive."  And even within that, it's never written as a simple, succinct finding you'd write as a note.  And this goes on for 20 pages for a single system.  There is no list along the lines of "Tendon function is normal. Capillary refill is less than 3 seconds in all extremities. Pulses palpable. Steady gait noted."

 

And this is for a paper that the teacher says is just a requirement and we should really be spending our time focusing on the practicum.  She said they're completely changing the class next year.

 

That's close but not quite in-depth enough.  I think I can start with this and add more detail.

What would the absence of those bolded abnormalities appear in terms of color, temperature, sensation, mobility, etc? 

What can be assessed in an observational physical assessment? 

The intention is to get you to understand how a normal human looks, sounds, feels and moves so that 1) you can recognize deviations from normal and 2) assist and plan for a return to the patient's "normal" after illness or injury. Read the book, all the sections.

[Kitiger, RN]

On 11/4/2021 at 10:45 PM, kpmadden83 said:

An example of the "normal findings" section I just randomly picked says "The modified Allen test is used to evaluate the adequacy of collateral circulation before cannulating the radial artery. Firmly occlude both the ulnar and radial arteries of one hand while the person makes a fist several times. This causes the hand to blanch. Ask the person to open the hand without hyperextending it; then release pressure on the ulnar artery while maintaining pressure on the radial artery. Adequate circulation is suggested by a palmar blush, a return to the normal color of the hand in less than 7 seconds. Although this test is simple and useful, it is relatively crude and subject to error (I.e., you must occlude both arteries uniformly with 11 pounds of pressure for the test to be accurate."

All of that for "Allen test positive."  And even within that, it's never written as a simple, succinct finding you'd write as a note.  And this goes on for 20 pages for a single system.  There is no list along the lines of "Tendon function is normal. Capillary refill is less than 3 seconds in all extremities. Pulses palpable. Steady gait noted."

Writing it out simply and succinctly would help me learn and remember it. If you don't want to write it out, you could record yourself . . . but the act of writing it helps me more.

If you read it with the goal of understanding, rather than memorizing, you will do better.

[PollywogNP, ADN, BSN, MSN, LPN, NP]

I taught physical assessment class ten semesters in a row using various textbooks and never saw a textbook that didn’t have the normal  and abnormal findings. What book are you using? 8 pages may be difficult to do unless you add the minute details as with the Allen test. BTW, not a test I do with physical exams.

[Tegridy]

8 pages is a lot, can’t even think of how to fill 8 pages worth of normal unless you put without XYZ… seems over the top

 

[Hannahbanana, BSN, MSN]

I must be missing something here. If an abnormal finding is XYZ, what reasonable person would be unable to deduce that a normal finding would be either absence of X, Y, or Z, or the opposite of X,  Y, or Z? 
For examples:

~ abnormal finding is a cool limb with lousy or absent pulses and capillary filling after blanching of >3 seconds, then a normal finding would be …? Warm limb and digits c pulses present at (site), capillary fill brisk at < 2 seconds

~ abnormal finding is drowsy and disoriented to day, date, and circumstances; normal is alert, responsive, and completely oriented

~ abnormal finding is stertorous breathing c absent breath sounds in bases and rales in upper lobes; normal is clear air exchange with no pharyngeal obstruction and lungs clear to auscultation in all lobes. 

~ abnormal: infant does not display rooting reflex by turning towards breast or touch to cheek, does not latch; normal is brisk rooting reflex and effective nursing with good latch

Let us not overthink this!