Chapter 3

• Approaching and Preparing the Client

  • Establish nurse-client relationship
  • Respect client’s desire and requests related to physical examination
  • Begin the examination with less intrusive behavior such as measuring client’s vital signs
  • Approach the client from the right-hand side of the examination table or bed because most examination techniques are performed with the examiner’s right hand (even if the examiner is left-handed)
• Equipment

  • Each part of the physical examination requires specific pieces of equipment
  • Necessary for each part of the examination and describes the general purpose of each piece of equipment
  • Prior to the examination, collect the necessary equipment and place it in the area where the examinations will be performed. This promotes organization
• Examinations that Use Equipments

  • All examinations
  • Vital signs
  • Nutritional status examination
  • Skin, hair, and nail examination
  • Head and neck examination
  • Eye examinations
  • Ear examinations
  • Mouth, throat, nose, and sinus examination
  • Thoracic and lung examination
  • Heart and neck vessel examination
  • Peripheral vascular examination
  • Abdominal examination
  • Musculoskeletal examination
  • Neurologic examination
  • Male genitalia and rectum examination
  • Female genitalia and rectum examination
• Four (4) Physical Examination Techniques

  • Inspection: use senses of vision, smell, and hearing
  • Palpation: use parts of the hand to touch and feel. Three different parts of the hand – fingerpads, ulnar/palmar surface, dorsal surface
  • Percussion: tapping body part
• Three (3) areas of physical assessment skills

  • Types and operation of equipment needed for the particular examination (e.g., Penlight, stethoscope, others)
  • Preparation of the setting, oneself, and the client for the physical assessment
  • Performance of the four assessment techniques: inspection, palpation, percussion, and auscultation
• Preparing oneself

  • Assess own feelings and anxieties before examining the client
  • Prevent the transmission of infectious agents
  • Always wear gloves
  • If a pin or other sharp object is used to assess sensory perception, discard the pin and use the new one for the next client
  • Wear mask or protective eye goggles
• Preparing the Physical Setting

  • Comfortable, warm room temperature
  • Private area free of interruptions from others
  • Quiet area free of distractions
  • Adequate lighting
  • Firm examination table or bed at a height that prevents stooping
  • A bedside table/tray to hold the equipment needed for the examination
• Palpation

  Use fingerpads, ulnar/palmar surface, and dorsal surface of the hand to touch and feel for pulses, tenderness, etc.
• Positions in examination

  • Sitting position
  • Supine position
  • Dorsal recumbent position
  • Sims’ position
  • Standing position
  • Prone position
  • Knee-chest position
• Types of percussion

  • Direct, blunt, indirect
• Palpation


  • Types: Light Palpation, Moderate Palpation, Deep Palpation, Bimanual Palpation
• Auscultation

  • Guidelines: Eliminate distracting noises, expose the body part, use diaphragm for high-pitched sounds, use bell for low-pitched sounds
• Physical examination techniques

  1. Inspection

  2. Palpation

  3. Percussion

  4. Auscultation
• Inspection

  • Make sure the room is comfortable, use good lighting, observe before touching, note characteristics like color and symmetry
• Percussion

  Tapping body parts to produce sound waves and assess underlying structures
• Auscultation

  Uses a stethoscope to listen for heart sounds, movement of blood, bowel sounds, and air movement in the respiratory tract
• Types of Palpation

  • Light Palpation
  • Moderate Palpation
  • Deep Palpation
  • Bimanual Palpation
• Percussion

  • Used for eliciting pain, determining location, size, shape, density, detecting abnormal masses
• Inspection

  Use senses of vision, smell, and hearing to observe characteristics like color, symmetry, etc.
• Prepared by Jhoelton Jayruss dela Cruz: ''