Physical examination

A systematic way of collecting objective data from a client using the four examination techniques in
order to assess or identify current health status.

Purposes of the physical examination:

• To obtain baseline data about the client’s functional abilities.

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

• To obtain data that will help establish nursing diagnoses and plans of care.

• To evaluate the physiological outcomes of health care and thus the progress of a client’s health
problem.

• To make clinical judgments about a client’s health status.

• To identify areas for health promotion and disease prevention.

Preparation Guidelines

1. Preparing the Client

- explain when and where the examination will take place, why it is important, and what will
happen
- ensuring confidentiality
- determine in advance any positions that are contraindicated for a particular client
- assists the client as needed to undress and put on a gown
- Clients should empty their bladders before the examination

2. Preparing the Environment

- The time for the physical assessment should be convenient to both the client and the nurse
- The environment needs to be well lighted and the equipment should be organized for
efficient use
- The room should be warm enough to be comfortable for the client
- privacy is important
- Culture, age, and gender of both the client and the nurse influence how comfortable the
client will be and what special arrangements might be needed

3. Positioning
- It is important to consider the client’s ability to assume a position
- The client’s physical condition, energy level, and age should also be taken into consideration
4. Draping
- Drapes should be arranged so that the area to be assessed is exposed and other body areas
are covered
- provide not only a degree of privacy but also warmth
5. Instrumentation
- All equipment required for the health assessment should be clean, in good working order,
and readily accessible
6. Methods of Examination
a. INSPECTION
- The visual examination, which is assessing by using the sense of sight.
- It should be deliberate, purposeful, and systematic.
- Olfactory (smell) and auditory (hearing) cues are also noted.
- Assess moisture, color, and texture of body surfaces, as well as shape, position, size, color,
and symmetry of the body.
- Lighting must be sufficient for the nurse to see clearly; either natural or artificial light can be
used.
- It is important to have a quiet environment for accurate hearing.

b. PALPATION
- Examination of the body using the sense of touch.
- The pads of the fingers are used because their concentration of nerve endings makes them
highly sensitive to tactile discrimination.
- Palpation is used to determine (a) texture (e.g., of the hair); (b) temperature (e.g., of a skin
area); (c) vibration (e.g., of a joint); (d) position, size, consistency, and mobility of organs or
masses; (e) distention (e.g., of the urinary bladder); (f) pulsation; and (g) tenderness or pain.
- Use the dorsum (back) of the hand and fingers, where the examiner’s skin is thinnest for
temperature
- To test for vibration, the nurse should use the palmar surface of the hand. General
guidelines for palpation include the following:
• The nurse’s hands should be clean and warm, and the fingernails short.
• Areas of tenderness should be palpated last.
• Deep palpation should be done after superficial palpation.

TWO TYPES

A. Light (superficial) palpation should always precede deep palpation because heavy pressure
on the fingertips can dull the sense of touch.
- The nurse extends the dominant hand’s fingers parallel to the skin surface and presses
gently while moving the hand in a circle
- If it is necessary to determine the details of a mass, the nurse presses lightly several times
rather than holding the pressure.
B. Deep Palpation
- Done with two hands (bimanually) or one hand.
- The nurse extends the dominant hand as for light palpation, then places the finger pads of
the nondominant hand on the dorsal surface of the distal interphalangeal joint of the middle
three fingers of the dominant hand.The top hand applies pressure while the lower hand
remains relaxed to perceive the tactile sensations.
- For deep palpation using one hand, the finger pads of the dominant hand press over the
area to be palpated. Often the other hand is used to support from below
c. PERCUSSION
- The act of striking the body surface to elicit sounds that can be heard or vibrations that can
be felt.

TWO TYPES
A. Direct percussion - the nurse strikes the area to be percussed directly with the pads of
two, three, or four fingers or with the pad of the middle finger.
- The strikes are rapid, and the movement is from the wrist.

B. Indirect percussion is the striking of an object (e.g., a finger) held against the body area
to be examined.
- In this technique, the middle finger of the nondominant hand, referred to as the pleximeter,
is placed firmly on the client’s skin. Only the distal phalanx and joint of this finger should be
in contact with the skin. Using the tip of the flexed middle finger of the other hand, called
the plexor, the nurse strikes the pleximeter, usually at the distal interphalangeal joint or a
point between the distal and proximal joints The striking motion comes from the wrist; the
forearm remainsstationary. The angle between the plexor and the pleximeter should be 90°,
and the blows must be firm, rapid, and short to obtain a clear sound.
- Percussion is used to determine the size and shape of internal organs by establishing their
borders.
- It indicates whether tissue is fluid filled, air filled, or solid.

TYPES OF SOUND EICITED IN PERCUSSION

A. Flatness is an extremely dull sound produced by very dense tissue, such as muscle or
bone.
B. Dullness is a thudlike sound produced by dense tissue such as the liver, spleen, or heart.
C. Resonance is a hollow sound such as that produced by lungs filled with air.
D. Hyperresonance is not produced in the normal body. It is described as booming and can
be heard over an emphysematous lung.
E. Tympany is a musical or drumlike sound produced from an air-filled stomach.

d. AUSCULTATION
- Auscultation is the process of listening to sounds produced within the body.

TWO TYPES
A. Direct auscultation is performed using the unaided ear, for example, to listen to a
respiratory wheeze or the grating of a moving joint.
B. Indirect auscultation is performed using a stethoscope, which transmits sounds to the
nurse’s ears. A stethoscope is used primarily to listen to sounds from within the body,
such as bowel sounds or valve sounds of the heart and blood pressure.