Preparing for the Examination
3 ASPECTS OF PREPARATION − Preventing the transmission of
• Preparing the physical setting
• Preparing oneself
• Approaching and preparing the client
PREPARING THE PHYSICAL SETTING
− Comfortable, warm room
temperature: Provide a warm blanket
if the room temperature cannot be
adjusted.
− Private area free of interruptions from
others: Close the door or pull the
curtains if possible. Quiet area free of
distractions: Turn off the radio,
television, or other noisy equipment.
− 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.
− 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.
− A bedside table/tray to hold the
equipment needed for the examination.
PREPARING ONESELF
− Assess your own feelings and
anxieties before examining the client.
− 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.
infectious agents.
− Always wear gloves if there is a
chance that you will come in direct
contact with blood or other body
fluids.
− 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).
APPROACHING AND PREPARING THE
CLIENT
− 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.
PREPARING THE PATIENT
− Explanation about the procedure
− When and where it will take place
− Importance
− What will happen during examination,
and it is painless
− Empty the bladder
− Sequence of assessment differ with
children and adult
 DRAPING INSPECTION

Drapes are made up of paper, cloth or bed − Concentrated watching/observing

linen. Drapes should be arranged so that the − Always comes first
area to be assessed is exposed and other − A focused inspection takes time and
body areas are covered. yields a surprising amount of data
− Requires good lighting, adequate
PHYSICAL EXAMINATION TECHNIQUES
exposure, and occasional use of certain
• Inspection instruments ( penlight, otoscope) to
enlarge your view
• Palpation
• Percussion To use the senses of vision, smell, and hearing
• Auscultation to observe the normal condition or any
deviations from normal of various body parts.
 • Expose body parts being observed • DORSA of hands-Temperature
while keeping the rest of the client detection
properly draped. • BASE of fingers or ulnar surface of
• Always look before touching. hands-vibration
• Use good lighting.
• Provide a warm room with good
ventilation
• Observe for color, size, location,
texture, symmetry, odors, and sounds.

PALPATION

− Using touch to detect variations in

normal and investigate abnormalities
− Should be slow and systematic
− Gentle, calm approach starting with
light palpation
− Be alert; short nails

To touch and feel body parts with hands to

determine the following characteristics:

a. texture (roughness/smoothness)

b. temperature (warm/hot/cold)

c. moisture (dry,wet, or moist)

d. motion (stillness/vibration)

e. consistency of structures (solid/fluid

filled)

Palpation Technique
▪ Examiner’s fingernails should be short

▪ The most sensitive part of the hand

should be used to detect various
sensations

▪ Light palpation precedes deep

palpation

▪ Tender areas are palpated last

Sense of Touch
• FINGERTIPS- Fine tactile
discrimination-skin texture, swelling,
lumps
 PERCUSSION
− eliciting pain
− determining location
− determining density
− detecting abnormal masses
− eliciting reflexes
AUSCULTATION
− Listening to sounds produced by the
body
− Use stethoscope to amplify sounds
− Become familiar with bell and
diaphragm
− Use tubing that is 12-18 inches long
− Warm chestpiece before using
− Keep instrument clean
− Better to listen under a gown than thru
a gown

To listen for various breath, heart, and bowel

sounds using a stethoscope.

Use a good stethoscope that has:

• Snug-fitting ear plugs

• Tubing not longer than 15 inches and
internal diameter not greater than inch
• Diaphragm and bell

STETHOSCOPE
• DIAPHRAGM-high pitched sounds
• BELL- soft, low-pitched sounds like
murmurs or extra heart sounds
• EARPIECES-point toward your nose

These Guidelines Should Be Followed As

You Practice The Technique Of
Auscultation:

o Eliminate distracting or competing

noises from the environment (e.g.,
radio, television, machinery).
o 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.