physical assesment

• Physical assessment


  Systematic, comprehensive, and continuous collection, validation, and communication of client's data using a variety of methods
• General considerations for physical assessment

  • Physical assessment is correlated with the patient's health history
  • Examiner should follow a certain sequence in doing physical assessment
  • Include only findings with medical significance
  • Findings should not only focus on symptoms that are present but also pertinent negatives
  • Results should be OBJECTIVE, and have NO EXAMINER VARIANCE
• Neurologic exam is always a part of the physical exam
• When examining a patient of the opposite sex, always have a companion of the same sex as the patient with you throughout the assessment
• Always maintain patient privacy
• The patient has the right to refuse to be examined, despite being an essential part of the history
• Approach to patient during physical assessment

  • Begin at the patient's right side, then moving to the opposite side of the patient, or foot of the bed as needed
  • Right JVP is more reliable
  • Right kidney is more palpable
• Approach to patient during physical assessment

  • When possible, begin with patient at sitting position
  • Completely expose part to be examined, but drape the rest of the body
  • Conduct the examination from head to toe (cephalocaudal)
  • Compare findings on both sides
  • Explain all procedures to avoid alarming the patient, and this encourages cooperation
  • Make patient as comfortable as possible
• Preparing the client


  • Introduce yourself
  • Tell the patient what you are going to do and why
  • Tell the patient the examination normally takes some time
  • Explain what you are doing every step of the way (as you go along)
• Considerations based on patient's age

  • Neonate
  • Infant
  • Toddler
  • School-age
  • Adolescent
  • Young Adult
  • Middle Aged Adult
  • Older Adult
• Preparing the client - Pregnant


  • Assess both woman and fetus
  • Include fundal height and fetal heart tone (FHT)
  • Assess for normal changes occurring in pregnancy
  • Pay special attention to nutritional assessment
  • Last trimester may have difficulty switching positions
  • Hormonal swings may exaggerate patient's responses
• Preparing the client - Disabled

  • Identify the disability
  • Focus on ability (functional, and mental capacity)
  • Modify assessment based on patient's needs (deaf written instructions or sign language)
  • Be alert and sensitive to patient's needs especially in unable to communicate verbally
• Positioning considerations


  • Supine
  • Prone
  • Sitting
  • Dorsal Recumbent
  • Lateral Recumbent
  • Sims Lateral
  • Knee Chest
  • Standing
  • Lithotomy
• Preparing the environment


  • Make sure room is quiet, private, warm, and well-lit
• Preparing the equipment


  • Clean
  • In working order
  • Readily accessible
• Patient's rights


  • Asking to see and get a copy of health records
  • Have corrections added to health information
  • Receive a notice informing him how health information is used or shared
  • Get a report on when and why health information is shared
  • Ask to be contacted somewhere other than at home
  • Ask that information not be shared
  • File complaints
• Be responsible and accountable for your practice
• Be a patient advocate
• Respect patient's rights
• Assure confidentiality of information/patient's data
• Equipment for physical examination

  • Gloves
  • Stethoscope
  • Sphygmomanometer
  • Thermometer
  • Watch with swift second hand
  • Flexible tape measure
  • Platform scale with height attachment
  • Ruler with centimeter markings
  • Magnifying glass
  • Penlight
  • Otoscope
  • Ophthalmoscope
  • Snellen chart
  • Cover card
  • Rosenbaum pocket screener
  • Tuning fork
  • Tongue depressor
  • Vaginal speculum
  • Reflex hammer
• Physical examination


  The process of evaluating objective anatomic findings through the use of observation, palpation, percussion, and auscultation
• Components of physical examination

  • Inspection
  • Palpation
  • Percussion
  • Auscultation
• Inspection


  • Look and observe before touching
  • Completely expose the body part and drape the rest
  • Note the following characteristics (color, patterns, size, location)
  • Compare the appearance of symmetric body parts
  • Direct - uses naked eye
  • Indirect - uses instruments to help enhance visualization
• Palpation


  • Parts of the Hands: Fingerpads, Ulnar and Palmar Surface, Dorsal Surface
  • Types of Palpation: Light Palpation, Moderate Palpation, Deep Palpation
• Percussion


  Involves tapping body parts to produce sound waves
• Types of percussion


  • Direct
  • Blunt
  • Indirect or Mediate
• Auscultation


  Type of assessment technique which usually require the use of a stethoscope to listen for sounds
• Auscultation


  • The sound heard during auscultation are classified according to intensity, pitch, duration, and quality
  • Parts Used: Bell - low pitch sounds, Diaphragm - high pitch sounds
  • Eliminate distracting or competing noises from the environment
  • Expose the body part
  • Use the appropriate part to auscultate either low or high pitch sounds
• Vital signs


  Reflects the body's physiologic status & ability to regulate temperature, maintain local and systemic blood flow, & oxygenate tissues
• Cardinal vital signs


  • Body Temperature
  • Pulse
  • Respirations
  • Blood Pressure
  • Pain
• Body temperature


  • Reflects the balance between the heat produced and heat loss
  • Core Temperature - temperature of the deep tissues in the body
  • Surface Temperature - temperature of the skin, subcutaneous tissue, & fats
• Heat production


  • Contributing Factors: Basal Metabolic Rate (BMR), Muscle activity, Thyroxine output, Stress, Fever
• Heat loss


  • Factors Affecting Heat Loss: Radiation, Conduction, Convection, Vaporization
• Factors affecting body temperature

  • Age
  • Diurnal Variations (circadian rhythm)
  • Exercise
  • Hormones
  • Stress
  • Environment
• Hyperthermia


  Abnormally high body temperature
• Fever types


  • Intermittent Fever
  • Remittent Fever
  • Relapsing Fever
  • Constant Fever
• Conduction


  Transfer of heat between two objects in contact
• Convection


  Dispersion of heat by air currents; warm air rises and is replaced by cooler air
• Vaporization


  Evaporation of moisture from body surfaces (i.e., insensible water and heat loss)