What Is a Comprehensive Health Assessment?

• Published On: January 3, 2020

A comprehensive health assessment gives nurses insight into a patient’s physical status through observation, the measurement of vital signs and self-reported symptoms. It includes a medical history, a general survey and a complete physical examination.

The general survey consists of a patient’s age, weight, height, build, posture, gait and hygiene. Nurses use health assessments to obtain baseline data about patients and to build a rapport with them that can ease anxiety and lead to a trusting relationship.

A comprehensive health assessment is generally conducted at the time of admission into an acute care facility or during the first visit to an outpatient clinic. When nurses perform an assessment, they may use techniques such as:

Inspection

This is the most frequently used method for assessment. Nurses look for indications of a health problem by using their eyes, ears and nose. They may inspect skin color, lesions, bruises or rashes as well as pay attention to abnormal sounds and odors.

Auscultation

Nurses listen to the sounds of the abdomen by placing the diaphragm or bell of a stethoscope on the bare skin of a patient.

Palpation

Nurses apply varying degrees of pressure on the patient with different parts of their hands. Palpation allows nurses to assess for texture, tenderness, temperature, moisture, pulsations and the presence of masses.

Percussion

Nurses firmly press on sections of a patient’s body with the distal part the middle finger on their non-dominant hand. The technique is used directly over suspected areas of tenderness to check a patient’s level of discomfort.

What Steps Are Involved in a Comprehensive Health Assessment?

Typically, a comprehensive assessment begins with documenting a patient’s health history before starting a physical exam. According to AMN Healthcare Education Services, the health history includes: the patient’s medical complaint, present state of health, past health record, current lifestyle, psychosocial status and family history.

The health history provides nurses with in-depth information about symptoms, childhood illnesses, related medical experiences and risks for developing certain diseases.

After the health history data is recorded, a physical is conducted which covers a review of the patient’s body systems. A head to toe examination includes assessments of the following:

• Skin
• Neurological function
• Ears, eyes, nose and throat
• Respiratory function
• Cardiac-pulmonary system
• Abdomen
• Muscles and joints
• Limbs, shoulders, hips, ankles and feet
• Reproductive system
• Nutrition

A thorough and accurate assessment is important because it helps differentiate the normal condition of the patient from the abnormal. And, a comprehensive health assessment establishes if a patient needs diagnostic testing or additional medical care.

(5) Complete Physical Assessment - YouTube