The Physical Examination

• Materials/Equipment needed for assessment

  • Cotton ball and paper clip
  • Cotton tipped-applicators
• Basic Knowledge in 3 Areas a Nurse Must Have

  • Types and operation of equipment needed for the particular examination
  • Preparation of the setting, oneself, and the client for physical assessment
  • Performance of the four assessment techniques: Inspection, Palpation, Percussion, Auscultation
• Preparing the Physical Settings

  1. Comfortable, warm room temperature

  2. Private area free of interruptions from others

  3. Quiet area free of distractions

  4. Adequate lighting

  5. Firm examination table or bed at a height that prevents stooping

  6. A bedside table/tray to hold the equipment needed for the examination
• Performance of the Four Assessment Techniques

  1. Inspection

  2. Palpation

  3. Percussion

  4. Auscultation
• Physical Examination

  1. A systematic way of collecting objective data from a client using the four examination techniques

  2. To assess or identify current health status
• Equipment needed for physical examination

  • Cotton ball and paper clip
  • Cotton tipped-applicators
• Preparing Oneself

  1. Assess your own feelings and anxieties before examining the client

  2. Wash your hands before beginning the examination

  3. Always wear gloves if there is a chance that you will come in direct contact with blood or other body fluids

  4. If a pin or other sharp object is used to assess sensory perception, discard the pin and use a new one for your next client

  5. Wear a mask and protective eye goggles if you are performing an examination in which you are likely to be splashed with blood or other body fluid droplets
• Preparation Guidelines

  1. Introduce self to the client. Verify his identity. Explain the purpose why such procedure is necessary and how he could cooperate

  2. Help him put on a clean gown and offer a bedpan or a urinal to empty his bladder

  3. Ensure privacy by closing the doors or pulling the curtains around him

  4. Invite a relative or a significant other to stay with the client, as necessary

  5. Provide adequate lighting

  6. Gather the materials or equipment

  7. Ensure the examination table is at a comfortable working height. Perform hand hygiene
• Collecting objective data: The physical examination (IPPA)

  1. Measure degree of flexion and extension of joints

  2. Provide lubrication for vaginal or rectal examination

  3. Dilate nares for inspection of the nose

  4. Inspect the anterior structures of the eye

  5. Inspect the tympanic membrane and external ear canal

  6. Provide a direct light source and test pupillary reaction

  7. Test deep tendon reflexes

  8. Measure organs, masses, growths, and lesions

  9. Outline masses or enlarged organs

  10. Collect specimens of body fluids, drainage, or tissue

  11. Measure systolic and diastolic blood pressure

  12. Auscultate body sounds

  13. Measure the height of the patient

  14. Measure the circumference of the head, abdomen, and extremities

  15. Measure body temperature

  16. Depress the tongue during assessment of the mouth and throat

  17. Test auditory function and vibratory sensation

  18. Test near and far vision

  19. Measure the weight of the patient

  20. Time heart rate, fetal pulse, or bowel sound when counting
• Materials/Equipment needed

  • Cotton ball and paper clip
  • Cotton tipped-applicators
  • Dental mirror
  • 4x4 gauze
  • Gloves
  • Goggles
  • Goniometer
  • Lubricant
  • Nasal speculum
  • Ophthalmoscope
  • Otoscope
  • Penlight
  • Reflex hammer
  • Ruler, marked in cm
  • Skin-marking pen
  • Specimen containers
  • Sphygmomanometer
  • Stethoscope
  • Stadiometer
  • Tape measure
  • Thermometer
  • Tongue blade
  • Tuning fork
  • Vision chart (Snellen chart)
  • Weighing scale
  • Watch with second hand
• Positioning your client

  1. Standing position

  2. Sitting or standard Fowler's position

  3. Semi-Fowler's position

  4. High Fowler's position

  5. Dorsal recumbent position

  6. Supine position

  7. Prone position

  8. Sim's position
• Client positioning for assessment

  • Prone position
  • Sim's position
  • Lithotomy position
  • Knee chest position
• Basic techniques of physical assessment

  1. Inspection

  2. Palpation

  3. Percussion

  4. Auscultation
• Types of consent

  • General consent
  • Informed consent
• Specific characteristics of the body assessed through palpation

  • Texture
  • Temperature
  • Moisture
  • Mobility
  • Consistency
  • Strength of Pulses
  • Size
  • Shape
  • Degree of Tenderness
• Things to consider when inspecting
• Client positioning for assessment

  1. Client lies down on the abdomen with the head to the side

  2. Client lies on the right or left side with the lower arm placed behind the body and the upper arm flexed at the shoulder and elbow

  3. Client lies on the back with the hips at the edge of the examination table and the feet supported by stirrups

  4. Client kneels on the examination table with the weight of the body supported by the chest and knees. A 90-degree angle should exist between the body and the hips. The arms are placed above the head, with the head turned to one side
• Inspection


  Observing the patient in a deliberate, systemic manner using the senses of vision, smell, and hearing to detect any normal or abnormal findings
• Types of consent
• Contraindications for specific client positions
• Parts of hand to use when palpating

  • Fingerpads
  • Ulnar or Palmar Surface
  • Dorsal (back) surface
• Palpation


  Assessing the client through the sense of touch to determine specific characteristics of the body
• Deep Palpation


  Allows feeling of very deep organs or structures covered by thick muscle, providing extra support and pressure to palpate at a deeper level from 2 to 4 cm
• Percussion


  Involves tapping body parts to produce sound waves, enabling assessment of underlying structures, with uses like eliciting pain, determining location, size, shape, density, detecting abnormal masses, and reflexes
• Light Palpation


  1. Used to feel for pulses, tenderness, surface skin texture, temperature, and moisture

  2. Finger pads of the dominant hand are placed on the surface of the area to be examined, feeling the surface structure using a circular motion at a depth of ≤1 cm
• Degree of Tenderness


  The sensitivity to touch that indicates tenderness in a specific area
• Auscultation


  The skill of listening to sounds produced by the body, requiring a quiet environment to listen for characteristics of each sound
• Diaphragm Side of Stethoscope
• Stethoscope Parts
• Parts of hand used when palpating

  • Fingerpads
  • Ulnar or Palmar Surface
  • Dorsal (back) surface
• Moderate Palpation


  Used to assess most other structures of the body, determining depth, size, shape, consistency, mobility of organs, pain, or pulsations present by depressing the skin surface 1 to 2 cm with the dominant hand using a circular motion
• Bimanual Palpation


  Using two hands, one on each side of the body part being palpated, to apply pressure and feel the structure, noting size, shape, consistency, and mobility
• Types of Percussion

  1. Direct Percussion

  2. Blunt Percussion

  3. Indirect Percussion
• Bell Side of Stethoscope
• Percussion Sounds

  • Hyperresonance
  • Resonance
  • Tympany
  • Dullness
  • Flatness