PHYSICAL
Obtain data that will help establish
EXAMINATION
-defined as a complete assessment of a
patient’s physical and mental status.
-is the systematic collection of objective
information that is directly observed or is
elicited through examination techniques
• “head-to-toe”.
THREE TYPES
• Complete Assessment
• Examination of body system
• Examination of body area (lungs-
DOB)
NURSING CONSIDERATIONS
1. Age of the patient
2. Severity of the illness
3. Preferences of the nurse
4. Location of the examination
CONSIDERATIONS
• Client’s ENERGY and TIME need to
be considered.
• Must done in a systematic and
efficient manner
• Requires the fewest position changes
of the patient
PURPOSES
1. Obtain a baseline data about the
client’s functional abilities
2. Supplement, confirm or refute data
obtained in the nursing history
3.
nursing diagnosis and plans of care
4. Evaluate the physiologic outcomes
of healthcare and thus the progress of
a client’s health problem
5. Make clinical judgments about a
client health status
6. Identify areas for health promotion
and disease prevention
BASIC KNOWLEDGE ON
THREE AREAS
1. EQUIPMENT
used in a particular examination
2. PREPARATION FOR THE
EXAMINATION
- settings
-examiner
-client
3. PERFORMANCE
of the FOUR ASSESSMENT
TECHNIQUES
1. EQUIPMENT used in a particular
examination
- name, operation and purpose of
equipment
-clean/aseptic, in good working
order & readily accessible
- all prepared before examination

2. PREPARATION FOR THE
EXAMINATION
A. SETTING
 warm room temperature
 Provide privacy
 Quiet area free of distractions
 Well lighted/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
B. PREPARING ONESELF/EXAMINER
 Awareness of feelings and anxieties
 Awareness on prevention of
transmission of infectious diseases
GENERAL PRINCIPLES TO KEEP IN
MIND WHILE PERFORMING
PHYSICAL ASSESSMENT
1. Wash your hand.
1.1. before the beginning of
examination
1.2. immediately after accidental
direct contact with blood/body fluids.
1.3. after completing the physical
examination/after removing gloves
2. Always wear gloves.
WHEN?
 There is a chance that you
will come in direct contact with
blood or other fluids
 Nurse has open cut or skin abrasion
 Client has an open or weeping a cut
 Collecting body fluids specimen –
blood, sputum, urine, stool, wound
drainage
 Handling contaminated
surfaces/instruments- linen, vaginal
speculum, tongue blades/depressor
 Performing examination of mouth,
genitalia, open wound, rectum
 When to change gloves:
 -when moving from a
contaminated to a clean body site
and between patients
 3. If pin or sharp object is used to
assess sensory perception, discard
and use a new one for next client
 4. Wear mask or protective eye
goggles if you are likely to be
splashed with blood or other
bloody fluid
3. Approaching And Preparing The
Client
 Establish rapport during interview
before PA takes place.
 Explain the purpose and describe the
examination to be performed
 Explain that all information gathered
and documented will remain
confidential.
 Respect your client’s desire and
request
 If necessary, you can ask the client to
sign a consent form before
examination ( vaginal or rectal)
 Explain that the assessment are
painless
 Determine in advance any position
that is contraindicated to your clients
 Tell to empty the bladder before
examination. If urine specimen is
needed, explain to the client the
purpose and procedure. Provide
container.
 Ask/assist the client to undress and
change to examination gown.
Provide privacy . Use a drape
 Begin the examination with less
intrusive procedures.
 Throughout the examination,
continue to explain the procedure
and why you are performing it.
 Try to integrate health teaching while
examining
 Approach the client from the right
hand side of the examination table or
bed.
 Ask/assist to change position
depending on the part of body to be
examined. Explain the need of
change.
CONSIDERATIONS WHEN
EXAMINING A CHILD
 Always proceed from less intrusive
to more invasive .

CONSIDERATIONS WHEN
EXAMINING AN ADULT
• Be aware of normal physiologic
changes that occur with age
• Be aware of stiffness of muscles or
joints – due to age or history of
surgery
• Expose only the areas of body to be
examined
• Permit ample of time for the client to
answer questions
• Beware for cultural differences
• Arrange an interpreter if there is
language barrier
• Ask client how they wish to be
addressed
• Adapt assessment techniques to any
sensory impairment
CONSIDERATIONS WHEN
EXAMINING AN ELDERLY
• Perform the examination that
minimizes changes in position
• Allow rest periods if needed
• Explain the procedure and integrate
teaching in a clear and slow manner
• More acceptable to be more formal
than informal
• Keep your voice volume down if
there is hearing problem. Speak
clearly at a moderate pace. Face the
client when speaking
• If cognitive impairment is assessed,
give only one- step direction and
avoid questions that require 2
responses
• If need validation to SO, avoid
consulting in the presence of the
client.
include head, neck, chest,
axillae, lungs, heart,
extremities, breasts, and
peripheral pulses.
• SIMS’ Position
• This position is useful for
assessing the rectal and
vaginal areas.
• Standing Position
• This position allows the
examiner to assess posture,
balance, and gait.

POSITIONING • This position is also used for

• Sitting Position
• This position is good for
evaluating the head, neck,
lungs, chest, back, breasts,
axillae, heart, vital signs, and
upper extremities.
• Supine Position
• This position allows the
abdominal muscles to relax
and provides easy access to
peripheral pulse sites.
• Areas assessed with the client
in this position may include
head, neck, chest, breasts,
axillae, abdomen, heart,
lungs, and all extremities.
examining the male genitalia.
• Prone Position
• The prone position is used
primarily to assess the hip
joint.
• The back can also be
assessed with the client in
this position.
• Knee–Chest Position
• useful for examining the
rectum.
• Lithotomy Position
• used to examine the female
genitalia, reproductive tracts,
and the rectum.

• Dorsal Recumbent Position

• This position may be more
comfortable than the supine
position for clients with pain
in the back or abdomen.
• Areas that may be assessed
with the client in this position
 COLOR, PATTERN, SIZE, LOCATION,
DRAPING
CONSISTENCY, SYMMETRY,
• Expose the body part you are going MOVEMENT, BEHAVIOR, ODOR OR
to assess SOUNDS
3. PERFORMANCE of the FOUR 6. Compare the appearance of symmetric
ASSESSMENT TECHNIQUES body parts

-inspection or both sides of any individual body part.

-palpation 7. When using auditory senses, quiet env’t is

-percussion needed for accurate hearing

-auscultation

INSPECTION PALPATION
 involves using the senses of vision,
smell, and hearing to observe and  using parts of the hand to touch and
detect any normal or abnormal feel for the following characteristics:
findings  help to detect outline of organs such
as thyroid, spleen or liver and
1. Moisture mobility of masses.
2. Color  detects body temperature, moisture,
3. Texture turgor, texture, tenderness, thickness
4. Shape and distention
5. Position
6. Size
7. Symmetry of the body PARTS OF THE HAND USED DURING
PALPATION
GUIDELINES IN INSPECTION • Finger pads- pulses, texture, size,
1. The room is in comfortable consistency, shape, crepitus
temperature. • ulnar/palmar surface-vibrations,
2. Used good lighting, preferably the thrills, fremitus
sunlight. • dorsal surface- temperature
3. Look and observe before touching
4. Completely exposed the body part
you are inspecting.
5. Note the following characteristics:
GUIDELINES IN PALPATION
• Help client to relax and be
comfortable because muscle tension
impairs effective assessment.
• Advise client to take slow deep
breaths during palpation
• Palpate tender areas last and note
nonverbal signs of discomfort.
• Rub clean hands to warm them, have
short fingernails and use gentle touch
• Standard precaution should be
followed if applicable.
• Start light palpation progressing to
deep palpation
TYPES OF PALPATION
1. LIGHT PALPATION
2. MODERATE PALPATION
3. DEEP PALPATION
4. BIMANUAL PALPATION
PERCUSSION
• Use two hands, placing one on each
side of the body part (e.g., uterus,
breasts, spleen) being palpated
• Use one hand to apply pressure and
the other hand to feel the structure.
.
THREE TYPES OF PERCUSSION
1. DIRECT PERCUSSION
- direct tapping of a body part with one or
two fingertips to elicit possible tenderness
(e.g., tenderness over the sinuses).
2. BLUNT PERCUSSION
-used to detect tenderness over organs (e.g.,
kidneys) by placing one hand flat on the
body surface and using the fist of the other
hand to strike the back of the hand flat on
the body surface.
3. INDIRECT/MEDIATE PERCUSSION
- the most commonly used
method of percussion.
- The tapping done with this
type of percussion produces a
sound or tone that varies with
the density of underlying
structures
Uses PLEXIMETER and PLEXOR
• PLEXIMETER
• Middle finger of the
non-dominant hand
• PLEXOR
• Tip of the flexed
middle finger of the
other hand and will
strike the pleximeter
--as density increases, the sound of
the tone becomes quieter.
Solid tissue-soft tone
Fluid- loud tone
 GUIDELINES IN AUSCULTATION
AUSCULTATION
1. Eliminate distracting or competing sounds
• Listening to sounds produced within
the body. 2. Expose the body part that you are going
to auscultate
Can be done :
3. Use the diaphragm of the stethoscope to
 Direct- Use of the unaided ear listen to high pitched sounds such as normal
 Indirect- Use of stethoscope heart sounds and bowel sounds and press
firmly on he body part being auscultated.

4. Use the bell to listen to low pitched
STETHOSCOPE sounds (abnormal heart sounds and bruits.
• Used primarily to listen to sounds Hold the bell lightly on the body part being
from within the body such as bowel auscultated
sounds, heart sounds, lung sounds
and blood pressure
BEFORE WE DO PHYSICAL
EXAMINATION
CLASSIFICATION OF SOUNDS IN 1. General survey
AUSCULTATION
• Appearance and mental status
• PITCH
• Vital signs
• Frequency of vibrations
• Height
• INTENSITY
• Weight
• Loudness/softness of a sound
2. Examination of body system
• DURATION
3. Integumentary system
• length
KEY POINTS
• QUALITY
• Inspect skin color, temperature,
• Subjective description moisture, texture.
(whistling, gurgling,
snapping) • Check skin integrity.
• Be alert for skin lesions.
• Evaluate hair condition; loss or
unusual growth.
• Note nail bed condition and capillary
refill.
 • HYPOPIGMENTATION-VITILIGO
SKIN • Patches of hypopigmented
skin
METHODS
• Destruction of melanocytes
• Inspection
• ALBINISM
• palpation
• Complete/partial lack of
INSPECTION
melanin
• PALLOR
• Striae (sometimes called stretch
• Absence of underlying red marks)
tones
• Seborrheic keratosis, a warty or
• Most evident in conjunctiva, crusty pigmented lesion
oral mucous membranes, nail
• Mole (also called nevus), a flat or
beds, palm of the hands and
raised tan/brownish marking up to 6
soles of the feet
mm wide
• Indicates anemia, illness,
PALPATION
emotional shock/stress
• Palpate skin to assess texture
• CYANOSIS
• Palpate to assess thickness
• Bluish tinge
• Palpate to assess moisture
• Most evident in nail beds,
lips, buccal mucosa • Palpate to assess temperature
• Indicates low oxygen levels • Palpate to assess mobility and turgor
in RBC
• Palpate to detect edema
• JAUNDICE
• EDEMA
• Yellowish-tinge
• Presence of excess interstitial
• Most evident in sclera, fluid
mucous membranes, skin
• Swelling or puffiness of the
• Increase amount of bilirubin tissue directly under your
in the blood skin, especially in your legs
or arm
• ERYTHEMA
• Stretched or shiny skin
• Redness associated with
variety of rashes • Skin that retains a dimple
(pits), after being pressed for
• HYPERPIGMENTATION
several seconds
• increase melanin (birthmark)
 • Increased abdominal size
• can be the result of
medication, pregnancy or an
underlying disease — often
congestive heart failure,
kidney disease or cirrhosis of
the liver.
GRADING OF PITTING EDEMA
• Grade 1: The pressure applied
leaves an indentation of 0–2
millimeters (mm) that rebounds
immediately. This is the least severe
type of pitting edema.
• Grade 2: The pressure leaves an
indentation of 3–4 mm that rebounds
in fewer than 15 seconds.
• Grade 3: The pressure leaves an
indentation of 5–6 mm that takes up
to 30 seconds to rebound.
• Grade 4: The pressure leaves an
indentation of 8 mm or deeper. It
takes more than 20 seconds to
rebound.

SKIN LESIONS
• PRIMARY
• Appear initially in
response to some
changes in the
external/internal
environment
• SECONDARY SKIN LESIONS
• Modification of a
primary lesion that results
from traumatic injury,
evolution from the
primary lesion, or other
external factors