IPPA

• Physical Examination Techniques

  1. Inspection

  2. Palpation

  3. Percussion

  4. Auscultation
• Types of Palpation

  • Light Palpation: To perform light palpation, place your dominant hand lightly on the surface of the structure. There should be very little or no depression. Use circular motion to feel pulse, tenderness, surface skin moisture, temperature & moisture
  • Moderate Palpation
• Inspection


  • Involves using the sense of vision, smell, & hearing to observe & detect any normal & abnormal findings
• Palpation


  • Examining the body through the sense of touch
• Assessing the Abdomen (IAPePa Technique)

  1. Inspection

  2. Auscultation

  3. Percussion

  4. Palpation
• Physical Assessment

  1. Determine the state of awareness of the client at the beginning of the physical examination

  2. Prepare the client physically and psychologically

  3. Protect the client’s privacy during the entire procedure

  4. Prepare the needed articles and equipment before the start of the procedure
• Physical Examination Techniques

  IPPA Technique: Inspection (1st technique), Palpation (2nd technique), Percussion (3rd technique), Auscultation (4th technique)
• Objective data

  • Information about the client directly observed by the nurse during interaction
  • Information elicited through physical assessment techniques
• Physical Assessment


  1. A complete assessment of the patient’s physical and mental status

  2. A systematic collection of objective information observed through examination techniques
• Inspection Purpose

  1. To gather baseline data about the client’s health

  2. To supplement, confirm or refute data obtained in the nursing history

  3. To confirm and identify nursing diagnoses

  4. To make clinical judgments about a client’s changing health status and management
• Parts of the hands when palpating

  • Finger pads
  • Ulnar or Palmar surface
  • Dorsal (back) surface
• Inspection


  • Make sure the room is in a comfortable temperature
  • Use good lighting, preferably sunlight
  • Look & observe before touching
  • Completely expose the body part being inspected while draping the rest of the client as appropriate
  • Note characteristics like color, patterns, size, location, consistency, symmetry, movement, behavior, odors, or sounds
  • Compare the appearance of symmetric body parts or both sides of any individual body part
• Moderate Palpation


  Depress the skin surface 1-2cm (0.5-0.75in) with your dominant hand & use circular motion to feel for easily palpable body organs and masses. Note size, consistency, & mobility of structures you palpate
• Bimanual Palpation


  Use two hands, placing one on each side of the body part (e.g. uterus, breast, spleen). Use one hand to apply pressure & other hand to feel the structure. Note the size, shape, consistency & mobility of the structure to palpate
• Uses of Percussion

  • Eliciting Pain
  • Determine location, size & shape
  • Determining density
  • Detecting abnormal masses
  • Eliciting reflexes
• Palpation


  Place your dominant hand lightly on the surface of the structure. There should be very little or no depression (less than 1cm). Feel the surface structure using a circular motion. Use this technique to feel pulse, tenderness, surface skin moisture, temperature & moisture
• Auscultation


  Type of assessment technique that requires the use of stethoscope to listen to heart sounds, movement of blood through the cardiovascular system, movement of bowel & movement of air through the respiratory tract
• A stethoscope is used because these body sounds are not audible to the human ear
• Types of Percussion

  • Direct Percussion
  • Blunt Percussion
  • Indirect/Mediate Percussion
• Indirect/Mediate Percussion


  Most common method of percussion. Tapping is done to produce sound or tone that varies with the density of underlying structures
• Types of Palpation

  • Moderate Palpation
  • Deep Palpation
  • Bimanual Palpation
• Direct Percussion


  Direct tapping of a body part with one or two fingertips to elicit possible tenderness (e.g. tenderness over the sinuses)
• Classifications of sounds detected using auscultation


  • Intensity (Loud or soft)
  • Pitch (High or Low)
  • Duration (Length)
  • Quality (Musical, crackling, raspy)
• Blunt Percussion


  Used to detect tenderness over organs by placing one hand flat on the body surface & using fist of the other hand to strike the back of the hand flat on the body surface
• Percussion


  Tapping body parts to produce sound waves. These sound waves or vibrations enable the examiner to assess underlying structures
• Deep Palpation


  Place your dominant hand on the skin surface & your non-dominant hand on top of your dominant hand to apply pressure. This should be about 2.5-5cm(1-2in). This allows you to feel very deep organs or structures that are covered by thick muscles