Physical examination

• Physical examination


  Conducted from head to toe (cephalocaudal technique)
• Determine the mental status and level of consciousness (LOC)

  At the beginning of examination
• Purposes of physical examination

  • Gather baseline data about the client's health
  • Supplement, confirm or refute data obtained in the midwifery history
  • Confirm & identify midwifery diagnosis
  • Make clinical judgments about a client's changing health status and management
  • Evaluate the physiological outcomes of care
• Preparation guidelines


  • Explain the procedure
  • Inform the client the need to assume a special position
  • Tell the client that appropriate draping will be provided
  • Control room temperature, and provide warm blanket
  • Ask the client to empty the bladder
  • Encourage the client to defecate
  • Use a relaxed voice tone and facial expressions to put the client at ease
  • Encourage the client to ask questions and report discomfort felt during the examination
  • Have a family member or a third person of the client's gender in the room during assessment of genitalia
  • At the conclusion of the assessment, ask the client if he or she has any concerns or questions
• Positions for physical examination

  • Sitting
  • Supine
  • Dorsal recumbent
  • Lithotomy
  • Sim's
  • Prone
  • Knee-chest (Genu-pectoral)
  • Fowler's
  • Trendelenburg
• Sitting position


  For the assessment of head, neck, back, posterior thorax, and lungs, breasts, axillae, heart, vital signs, and upper extremities
• Supine position


  For the assessment of head, and neck, anterior thorax, and lungs, breasts, axillae, heart, abdomen, extremities, pulses, vital signs, vagina
• Dorsal recumbent position


  For the assessment of head, neck, anterior thorax and lungs, breasts, axillae, heart and abdomen, extremities, peripheral pulses, vital signs and vagina
• Lithotomy position


  For the assessment of female genitalia, rectum and female reproductive tract
• Sim's position


  For the assessment of rectum and vagina
• Prone position


  For the assessment of posterior thorax, hip movement
• Knee-chest (Genu-pectoral) position


  For the assessment of rectum
• Fowler's position


  Semi-Fowler's - head of bed elevated at 15-45 degree angle, High Fowler's - head of bed raised at 80-90 degree angle
• Trendelenburg position


  For shock or low blood pressure, Abdominal surgery
• Techniques of physical assessment

  • Inspection
  • Auscultation
  • Palpation
  • Percussion
• Inspection


  Visual examination that is deliberate, purposeful, and systematic
• Auscultation


  Requires the use of stethoscope
• Factors/characteristics assessed by palpation

  • Texture
  • Temperature of skin area
  • Location/position, size, consistency, mobility of organs or masses
  • Distention
  • Pulsation
  • Presence of pain upon pressure
  • Presence of lumps
• Types of palpation


  • Light palpation
  • Moderate palpation
  • Deep palpation
  • Bimanual palpation
• Percussion


  Involves tapping body parts to produce sound waves that enable the examiner to assess underlying structures
• Sounds elicited by percussion

  • Resonance
  • Hyper-resonance
  • Tympany
  • Dullness
  • Flatness
• The sequence of methods for physical examination of the abdomen is Inspection, Auscultation, Percussion and Palpation (IAPePa). No abdominal palpation among clients with tumor of the liver or the kidneys.
• During physical examination of the abdomen, it is important to flex the knees to relax the abdominal muscles, thereby facilitating the examination of abdominal organs.
• The sequence of examining the abdomen is right lower quadrant, right upper quadrant, left upper quadrant and left lower quadrant (RLQ, RUQ, LUQ, LLQ).
• The best position when examining the chest is sitting/upright position. This enables the examiner to assess the anterior and posterior chest.
• The best position when examining the back is standing position. This enables the examiner to assess the posture, and the gait of the client.
• If instrumental vaginal examination is done, pour warm water over the vaginal speculum before use to ensure comfort.
• If a female client is examined by a male doctor, a female staff must be in attendance to ensure the procedure is done in an ethical manner.
• Organization of the examination

  • History taking precedes physical examination
  • The commonly used system is "head to toe" (cephalocaudal)
  • The extent of the examination depends on the purpose
  • If client becomes fatigued, offer rest periods between assessments
  • Record results of the examination in scientific terms so that any health professional can interpret the findings
• Components of general survey

  • Height and Weight
  • Vital Signs (Temperature, Pulse, Respiration, Blood Pressure)
  • General Appearance and Behavior (Sex and Race, Signs of Distress, Body Type, Posture, Gait, Body Movements, Age, Hygiene and Grooming, Dress, Body Odor, Mood and Affect/Facial Expression, Speech, Level of Consciousness)
• Core temperature


  The temperature of the deep tissues of the body, measured by taking oral and rectal temperature
• Surface temperature


  The temperature of the skin, subcutaneous tissue and fat, measured by taking axillary temperature
• Factors affecting the body's heat production

  • Basal Metabolic Rate (BMR)
  • Muscle Activity
  • Thyroxine Output
  • Epinephrine, norepinephrine, and sympathetic stimulation
  • Fever
• Processes involved in heat loss

  • Radiation
  • Conduction
  • Convection
  • Evaporation
• Factors affecting the body's heat production

  • Basal Metabolic Rate (BMR)
  • Muscle Activity
  • Thyroxine Output
  • Epinephrine, norepinephrine, and sympathetic stimulation
  • Fever
• Basal Metabolic Rate (BMR)


  The younger the person, the higher the BMR; the older the person, the lower the BMR. Therefore, the older persons, have lower body temperature than the younger persons.
• Muscle Activity


  Exercise increases body heat production
• Thyroxine Output


  Increases cellular metabolic rate. Hyperthyroidism is characterized by increased body temperature.
• Epinephrine, norepinephrine, and sympathetic stimulation

  Increase the rate of cellular metabolism. These in turn increase body temperature.
• Fever


  Increases the rate of cellular metabolism