Republic of the Philippines

CAVITE STATE UNIVERSITY

Don Severino de las Alas Campus
Indang, Cavite

COLLEGE OF NURSING

COLLECTION OF OBJECT
IVE
DATA

NURS 02

JOY B. DIMAYUGA
Learning Outcome:

After mastering the contents of this module, the student will be able to:

Assimilate knowledge on health assessment known for holistic perspective and step
by step approach and these concepts brings the students through every stage of nursing
assessment covering all physical systems.

Objectives:
This module aims to discuss the collection of objective data. With the help of this module the
students’ will be able to:
1. Describe the ways to prepare the physical environment and make it conducive to a
physical examination.
2. Explain the ways to prepare a client for a physical examination.
3. Described the various positions to perform a physical examination.
4. Demonstrate the correct method used for inspection during a physical examination.
5. Explain the purpose and differences between light, deep, and bimanual palpation.
6. Demonstrate the correct direct and indirect, and blunt percussion techniques used
during a physical examination.
7. Explain the correct use of a stethoscope and the purpose of the bell and the
diaphragm.
8. Survey the various pieces of equipment used to perform a physical examination.

Module Instruction: This module will serve as supplemental learning material to First Year
Nursing students of Cavite State University enrolled in NURS 02. Use this as a guide during
interactive online discussion as well as when complying with assigned requirements and
activities.

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 Topic 1. COLLECTING OBJECTIVE DATA: The Physical Examination:

Objective data include information about the client that the nurse directly
observes during interaction with the client and information elicited through physical
assessment (examination) techniques.

To become proficient with physical assessment skills, the nurse must have basic knowledge
in three areas:
1. Types and operation of equipment needed for the particular examination (e.g.,
penlight, sphygmomanometer, otoscope, tuning fork, stethoscope)
2. Preparation of the setting, oneself, and the client for the physical assessment
3. Performance of the four assessment techniques: inspection, palpation, percussion,
and auscultation

I. APPROACH AND OVERVIEW

Conduct a comprehensive physical examination on most new patients or patients being

admitted to the hospital. For more problem-oriented, or focused, assessments, the presenting
complaints will dictate which segments you elect to perform.

● The key to a thorough and accurate physical examination is a systematic sequence of

examination. With effort and practice, you will acquire your own routine sequence. This book
recommends examining from the patient’s right side.
● Apply the techniques of inspection, palpation, auscultation, and percussion to each
body region, but be sensitive to the whole patient.
● Minimize the number of times you ask the patient to change position from supine to
sitting, or standing to lying supine.
● For an overview of the physical examination, study the sequence that follows. Note
that clinicians vary in where they place different segments, especially for the musculoskeletal
and nervous systems.
A. BEGINNING THE EXAMINATION: SETTING THE STAGE
Take the following steps to prepare for the physical examination.
Preparing for the Physical Examination
 Reflect on your approach to the patient.
 Adjust the lighting and the environment.
 Make the patient comfortable.
 Determine the scope of the examination.
 Choose the sequence of the examination.
 Observe the correct examining position (the patient’s right side) and handedness.

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Prior to the examination, collect the necessary equipment and place it in the area where the
examination will be performed. This promotes organization and prevents the nurse from leaving
the client to search for a piece of equipment.
Think through your approach, your professional demeanor, and how to make the patient
comfortable and relaxed.

Always wash your hands in the patient’s presence before begin ning the examination.

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FIGURE 1. EQUIPMENT NEEDED FOR PHYSICAL EXAMINATIon FIGURE 2. EQUIPMENT
NEEDED FOR PHYSICAL EXAMINATION

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FIGURE 3. EQUIPMENT NEEDED FOR PHYSICAL EXAMINATION FIGURE 4. EQUIPMENT
NEEDED FOR PHYSICAL EXAMINATION

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 FIGU
RE 5.
EQUI
PME
NT
NEED
ED
FOR
PHYS
ICAL
EXA
MINA
TION
S

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B. PREPARING THE PHYSICAL SETTING.
The physical examination may take place in a variety of settings such as a hospital
room, outpatient clinic, physician’s office, school health office, employee health
office, or a client’s home. It is important that the nurse strive to ensure that the
examination setting meets the following conditions: o Comfortable, warm room
temperature: Provide a warm blanket if the room temperature cannot be adjusted. o
Private area free of interruptions from others: Close the door or pull the curtains if
possible. o Quiet area free of distractions: Turn off the radio, television, or other
noisy equipment. o Adequate lighting: It is best to use sunlight (when available).
However, good overhead lighting is sufficient. A portable lamp is helpful for
illuminating the skin and for viewing shadows or contours. o Firm examination table
or bed at a height that prevents stooping: A roll-up stool may be useful when it is
necessary for the examiner to sit for parts of the assessment.
o A bedside table/tray to hold the equipment needed for the examination

C. PREPARING ONESELF.
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  As a beginning examiner, it is helpful to assess your own feelings and anxieties
before examining the client. Anxiety is easily conveyed to the client, who may already
feel uneasy and self-conscious about the examination.
 Achieve self confidence in performing a physical assessment by practicing the
techniques on a classmate, friend, or relative.
 Encourage your ―pretend client‖ to simulate the client role as closely as possible. It
is also important to perform some of your practice assessments with an experienced
instructor or practitioner who can give you helpful hints and feedback on your
technique.
 Another important aspect of preparing yourself for the physical assessment
examination is preventing the transmission of infectious agents.
 Standard Precautions to be followed by all health care workers caring for clients
(CDC & HICPAC, 2007). General principles to keep in mind while performing a
physical assessment include the following:
 Wash your hands before beginning the examination, immediately after
accidental direct contact with blood or other body fluids, and after
completing the physical examination or after removing gloves.
 If possible, wash your hands in the examining room in front of the client.
This assures your client that you are concerned about his or her safety.
 Always wear gloves if there is a chance that you will come in direct contact
with blood or other body fluids.
 In addition, wear gloves if you have an open cut or skin abrasion, if the client
has an open or weeping cut, if you are collecting body fluids (e.g., blood,
sputum, wound drainage, urine, or stools) for a specimen, if you are
handling contaminated surfaces (e.g., linen, tongue blades, vaginal
speculum), and when you are performing an examination of the mouth, an
open wound, genitalia, vagina, or rectum. Change gloves when moving from
a contaminated to a clean body site, and between patients.
 If a pin or other sharp object is used to assess sensory perception, discard
the pin and use a new one for your next client.
 Wear a mask and protective eye goggles if you are performing an
examination in which you are likely to be splashed with blood or other body
fluid droplets (e.g., if you are performing an oral examination on a client who
has a chronic productive cough).

Figure 6. CDC* AND HICPAC† ISOLATION PRECAUTION GUIDELINES

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Figure 7. CDC* AND HICPAC ISOLATION PRECAUTION GUIDELINES

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D. APPROACHING AND PREPARING THE CLIENT.

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 Establish the nurse–client relationship during the client interview before the physical
examination takes place.
This is important because it helps to alleviate any tension or anxiety that the client is
experiencing. At the end of the interview explain to the client that the physical
assessment will follow and describe what the examination will involve. For example,
you might say to a client, ―Mr. Smith, based on the information you have given me, I
believe that a complete physical examination should be performed so I can better
assess your health status. This will require you to remove your clothing and to put on
this gown. You may leave on your underwear until it is time to perform the genital
examination.‖
Respect the client’s desires and requests related to the physical examination. Some
client requests may be simple, such as asking to have a family member or friend
present during the examination.
Another request may involve not wanting certain parts of the examination (e.g., breast,
genitalia) to be performed. In this situation, you should explain to the client the
importance of the examination and the risk of missing important information if any
part of the examination is omitted.
Ultimately, however, whether to have the examination is the client’s decision. Some
health care providers ask the client to sign a consent form before a physical
examination, especially in situations where a vaginal or rectal examination will be
performed.
If a urine specimen is necessary, explain to the client the purpose of a urine sample
and the procedure for giving a sample; provide him or her with a container to use. If a
urine sample is not necessary, ask the client to urinate before the examination to
promote an easier and more comfortable examination of the abdomen and genital
areas.
Ask the client to undress and put on an examination gown. Allow him or her to keep on
underwear until just before the genital examination to promote comfort and privacy.
Leave the room while the client changes into the gown and knock before reentering
the room to ensure the client’s privacy.
Begin the examination with the less intrusive procedures such as measuring the
client’s temperature, pulse, blood pressure, height, and weight. These
nonthreatening/nonintrusive procedures allow the client to feel more comfortable with
you and help to ease client anxiety about the examination.
Throughout the examination, continue to explain what procedure you are performing
and why you are performing it. This helps to ease your client’s anxiety. It is usually
helpful to integrate health teaching and health promotion during the examination
(e.g., breast self-examination technique during the breast examination).
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).
You may ask the client to change positions frequently, depending on the part of the
examination being performed.
Prepare the client for these changes at the beginning of the examination by explaining
that these position changes are necessary to ensure a thorough examination of each
body part and system.

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E. THE PHYSICAL EXAMINATION: SUGGESTED SEQUENCE AND POSITIONING

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FIGURE 8
. POSITIONING DURING PHYSICAL EXAMINATIONS

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FIGURE 9

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FIGURE 10
. POSITIONING DURING PHYSICAL EXAMINATIONS

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FIGURE 11
. POSITIONING DURING PHYSICAL EXAMINATIONS

f. f.

F.PHYSICAL EXAMINATION TECHNIQUES

Four basic techniques must be mastered before you can perform a thorough and complete
assessment of the client.
These techniques are.
1. inspection,
2. palpation,
3. percussion, 4. auscultation.
After performing each of the four assessment techniques, examiners should ask themselves
questions that will facilitate analysis of the data and determine areas for which more data
may be needed.
These questions include:

• Did I inspect, palpate, percuss, or auscultate any deviations from the normal
findings? (Normal findings are listed in the second column of the Physical
Assessment sections in the body systems chapters.)
• If there is a deviation, is it a normal physical, gerontologic, or cultural finding; an
abnormal adult finding; or an abnormal physical, gerontologic, or cultural finding?
• Based on my findings, do I need to ask the client more questions to validate or obtain
more information about my inspection, palpation, percussion, or auscultation
findings?
• Based on my observations and data, do I need to focus my physical assessment on
other related body systems?
• Should I validate my inspection, palpation, percussion, or auscultation findings with
my instructor or another practitioner?
• Should I refer the client and data findings to a primary care provider? These
questions help ensure that data is complete and accurate and that it will help to
facilitate analysis
.

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FIGURE 12

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INSPECTION - involves using the senses of vision, smell, and hearing to observe and detect
any normal or abnormal findings.

o This technique is used from the moment that you meet the client and continues
throughout the examination.
o Inspection precedes palpation, percussion, and auscultation because the latter
techniques can potentially alter the appearance of what is being inspected.
Although most of the inspection involves the use of the senses only, a few body
systems require the use of special equipment (e.g., ophthalmoscope for the
eye inspection, otoscope for the ear inspection). Use the following guidelines
as you practice the technique of inspection:
o Make sure the room is a comfortable temperature. A toocold or too-hot room
can alter the normal behavior of the client and the appearance of the client’s
skin.
o Use good lighting, preferably sunlight. Fluorescent lights can alter the true color
of the skin. In addition, abnormalities may be overlooked with dim lighting.
o Look and observe before touching. Touch can alter appearrance and distract
you from a complete, focused observation. o Completely expose the body part
you are inspecting while draping the rest of the client as appropriate.
o Note the following characteristics while inspecting the client: color, patterns,
size, location, consistency, symmetry, movement, behavior, odors, or sounds.
o Compare the appearance of symmetric body parts (e.g., eyes, ears, arms,
hands) or both sides of any individual body part

PALPATION- consists of using parts of the hand to touch and feel for the following
characteristics:

 Texture (rough/smooth)
 Temperature (warm/cold)
 Moisture (dry/wet)
 Mobility (fixed/movable/still/vibrating)
 Consistency (soft/hard/fluid filled)
 Strength of pulses (strong/weak/thready/bounding)
 Size (small/medium/large)
 Shape (well defined/irregular)
 Degree of tenderness

Three different parts of the hand are used during

palpation.
1. finger pads,
2. ulnar/ palmar surface,
3. dorsal surface—
Each part of the hand is particularly sensitive to certain
characteristics.

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Determine which characteristic you are trying to palpate and refer to Table 3-2 to find which
part of the hand is best.
Figures 8. Parts of hand to use when palpating

Hand Part Sensitive To

1. Finger pads Fine discriminations: pulses, texture, size,
consistency, shape, crepitus

2. Ulnar/ palmar surface Vibrations, thrills, fremitus

3. Dorsal surface Temperature

Several types of palpation

1. light
2. moderate
3. deep
4. bimanual palpation.
The depth of the structure being palpated and the thickness of the tissue overlying that
structure determine whether you should use light, moderate, or deep palpation.
Bimanual palpation is the use of both hands to hold and feel a body structure.

In general, the examiner’s fingernails should be short and the hands should be a comfortable
temperature.
Proceed from light palpation, which is safest and the most comfortable for the client, to
moderate palpation, and finally to deep palpation.
Specific instructions on how to perform the four types of palpation
follow:
• Light palpation: To perform light palpation, place your
dominant hand lightly on the surface of the structure. There
should be very little or no depression (less than 1 cm). Feel
the surface structure using a circular motion. Use this
technique to feel for pulses, tenderness, surface skin
texture, temperature, and moisture.
• Moderate palpation: Depress the skin surface 1 to 2
cm (0.5 to 0.75 inch) with your dominant hand and use a
circular motion to feel for easily palpable body organs and
masses. Note the size, consistency, and

mobility of structures you palpate.

• Deep palpation: Place your dominant hand on the skin
surface and your nondominant hand on top of your hand to apply pressure . This
should result in a surface depression between 2.5 and 5 cm (1 and 2 inches).
This allows you to feel very deep organs or structures that are
covered by thick muscle.

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 • Bimanual palpation: 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. Note the size, shape,
consistency, and mobility of the structures you palpate.

PERCUSSION - involves tapping body parts to produce sound waves. These sound waves or
vibrations enable the examiner to assess underlying structures.
Percussion has several different assessments uses, including:

• Eliciting pain: Percussion helps to detect inflamed underlying structures. If an inflamed

area is percussed, the client’s physical response may indicate or the client will report that
the area feels tender, sore, or painful.
• Determining location, size, and shape: Percussion note changes between borders of an
organ and its neighboring organ can elicit information about location, size, and shape.
• Determining density: Percussion helps to determine whether an underlying structure is
filled with air or fluid or is a solid structure.
• Detecting abnormal masses: Percussion can detect superficial abnormal structures or
masses. Percussion vibrations penetrate approximately 5 cm deep. Deep masses do not
produce any change in the normal percussion vibrations.
• Eliciting reflexes: Deep tendon reflexes are elicited using the percussion hammer.
The three types of percussion are as follows:

1. Direct percussion-(Fig.
3-4) is the direct tapping of
a body part with one or two
fingertips to elicit possible
tenderness (e.g.,
tenderness over the
sinuses)

2. Blunt percussion-Fig. 3-
5) is used to detect tenderness over organs (e.g., kidneys) by
placing one hand flat on the body surface and using the fist of
th other hand to strike the back of the hand flat on the body
surface.

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 3. Indirect percussion-(Fig.
3-6) is the most used
method of percussion. The
tapping done with this type
of percussion produces a
sound or tone that varies
with the density of
underlying structure.

The tapping done with this type of percussion produces a sound or tone that varies with the
density of underlying structures.
As density increases, the sound of the tone becomes quieter.
Solid tissue produces a soft tone, fluid produces a louder tone, and air produces an even
louder tone.
These tones are referred to as percussion notes and are classified according to origin, quality,
intensity, and pitch (Table 3-3)

Note: Watch this youtube link for further understanding of the Percussion sound.
https://youtu.be/Lhe06ZTBV_A
https://youtu.be/84AzA_SmLaQ
The following techniques help to develop proficiency in the technique of indirect percussion:

• Place the middle finger of your nondominant hand on the body part you are
going to percuss.
• Keep your other fingers off the body part being percussed because they will
damp the tone you elicit.
• Use the pad of your middle finger of the other hand (ensure that this fingernail
is short) to strike the middle finger of your nondominant hand that is placed on
the body part.

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 • Withdraw your finger immediately to avoid damping the tone.  Deliver two
quick taps and listen carefully to the tone.
• Use quick, sharp taps by quickly flexing your wrist, not your forearm.
Practice percussing by tapping your thigh to elicit a flat tone and by tapping your puffed-out
cheek to elicit a tympanic tone. A good way to detect changes in tone is to fill a carton
halfway with fluid and practice percussing on it. The tone will change from resonance over
air to a duller tone over the fluid.
AUSCULTATION - is a type of assessment technique that requires the use of a
stethoscope to listen for heart sounds, movement of blood through the cardiovascular
system, movement of the bowel, and movement of air through the respiratory tract.
A stethoscope is used because these body sounds are not audible to the human ear. The
sounds detected using auscultation are classified according to the intensity (loud or soft), pitch
(high or low), duration (length), and quality (musical, crackling, raspy) of the sound (see
Assessment Guide 3-1).

These guidelines should be followed as you practice the technique of auscultation:

Eliminate distracting or competing noises from the environment (e.g., radio, television,
machinery).
Expose the body part you are going to auscultate. Do not auscultate through the client’s
clothing or gown. Rubbing against the clothing obscures the body sounds.

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 Use the diaphragm of the stethoscope to listen for highpitched sounds, such as normal
heart sounds, breath sounds, and bowel sounds, and press the diaphragm firmly on
the body part being auscultated.
Use the bell of the stethoscope to listen for low-pitched sounds such as abnormal
heart sounds and bruits (abnormal loud, blowing, or murmuring sounds).
Hold the bell lightly on the body part being auscultated. Note: Watch this
youtube link for further understanding of the IPPA.
https://youtu.be/_JsU-o3t0uM

SUMMARY
Collecting objective data is essential for a complete nursing assessment.
The nurse must have knowledge of and skill in three basic areas to become
proficient in collecting objective data:
necessary equipment and how to use it; preparing the
setting, oneself, and the client for the examination. and
how to perform the four basic assessment techniques.
Collecting objective data requires a great deal of practice to become proficient.
Proficiency is needed because how the data are collected can affect the accuracy of
the information elicited.

Learner Activities

1. Recall a time when you were about to have a physical examination.

Remember the anxieties and concerns you were feeling. What were your greatest
fears?
2. When might you use deep palpation during a physical examination? Bimanual
palpation? Direct percussion? Indirect percussion?
3. Describe how would you prepare yourself to perform a total physical examination
of a client of the opposite sex. Describe how you would prepare th e client both
emotionally and physically.

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