PHYSICAL

ASSESSMENT
Presented by: Joanna Marie McPherson De
Guzman
 PHYSICAL ASSESSMENT

• A physical examination is a routine test your

primary care provider (PCP) performs to
check your overall health. A PCP may be a
doctor, a nurse practitioner, or a physician
assistant. The exam is also known as a
wellness check.
 PHYSICAL ASSESSMENT
• A complete health assessment may be conducted
starting from the head and proceeding in a systematic
manner downward (head-to-toe assessment).
• However, the procedure can vary according to the age of
the individual, the severity of the illness, the preference
of the nurse, the location of the examination, the
agency’s priorities and procedures.
 PHYSICAL ASSESSMENT
• The health assessment is therefore conducted in a systematic
and efficient manner that the results in the fewest position
changes for the client.
• Frequently nurses assess a specific body area instead of the
entire body. These specific assessments are made in relation to
client complaints, the nurse’s own observation of problems, the
client’s presenting problem, nursing interventions provided, and
medical therapies.
Purposes of the Physical examination:

• To obtain baseline data about the client’s

functional abilities.
• To supplement, confirm, or refute data obtain in the
nursing history.
• To obtain data that will help establish nursing
diagnoses and plans of care.
 Purposes of the Physical examination:

• To evaluate physiological outcomes of health care

and thus the progress of a client’s health problem.
• To make clinical judgements about a client’s health
status.
• To identify areas for health promotion and disease
prevention.
 PHYSICAL ASSESSMENT
• Nurses use national guidelines and evidence-based practice to
focus health assessment on specific conditions. The nurse’s
judgement is key when the evidence is inconclusive or
conflicting.
• Most people need an explanation of the physical examination.
Often clients are anxious about what the nurse will find. They
can be reassured during the examination by explanations at
each step.
 PHYSICAL ASSESSMENT
• The nurse should explain when and where the examinations
will take place, why it is important, and what will happen.
Instruct the client that all information gathered and
documented during the assessment is kept confidential in
accordance with the health insurance portability and
accountability act (HIPAA). This means that only those health
care providers will have a legitimate need to know the client’s
information and have access to it.
 PHYSICAL ASSESSMENT
• Health examinations are usually painless; however, it is
important to determine in advance any positions that is
contraindicated for a particular client.
• The nurse assists the client as needed to undress and put a
gown. Clients should empty their bladders before the
examination.
• Doing so helps them feel more relaxed and facilitates
palpation of the abdomen and the pubic area. If a urinalysis is
required, then the urine should be collected in a container for
 PHYSICAL ASSESSMENT
• The sequence of assessment differs with children and
adults. With children, always proceed from the least
invasive or uncomfortable aspect of the exam to be
more invasive. Examination of the neck, heart, and
lungs, and range of motion can be done early in the
process, with the ears, mouth, abdomen and genitals
being left for the end of the exam
 Preparing the environment
• It is important to prepare the environment before starting the
assessment. The time for the physical assessment should be
convenient to both the client and nurse.
• The environment should be well lighted and the equipment
should be well organized for efficient use. A client who is
physically relaxed will usually experience little discomfort. The
room should be warm enough to be comfortable for the client.
 Preparing the environment
• Providing privacy is important. Most people are embarrassed if
their bodies are exposed or if others can overhear or view them
during the assessment. 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. For example,
if the client and the nurse should ask if it is acceptable to
perform the physical examination. Family and friends should not
be present unless the client asks for someone.
 Positioning

• Several positions are frequently required during the physical assessment.

It is important to consider the client’s ability to assume the position.
• The client’s physical condition, energy level, and age should also be taken
into consideration. Some positions are embarrassing and uncomfortable
therefore should not be maintained for long.
• The assessment is organized so that several body areas can be
assessed in one position, thus minimizing the number of position changes
needed
 Positioning
Supine /Horizontal
Dorsal Recumbent recumbent
 Positioning

Sitting Lithotomy
 Positioning

Sim’s Lateral Prone

 Draping

• Drape should be arranged so that the area to

be assessed is exposed and other body areas
are covered. Exposure of the body is frequently
embarrassing to clients. Drapes provide not
only a degree of privacy but also warmth.
Drapes are made of paper, cloth, or bed linen.
Draping
 Instrumentation

• All equipment required for the health

assessment should be clean, in good working
order, and readily accessible. Equipment is
frequently set up on trays, ready for use.
Penlight

• To assist viewing of the

pharynx or to
determine the reactions
of the pupils of the eye.
Ophthalmoscope

• A lighted instrument to
visualized the interior
of the eye
Otoscope
• A lighted instrument to
visualize the eardrum
and external auditory
canal (a nasal speculum
may be attached to the
otoscope to inspect the
nasal cavities)
Percussion Hammer

• An instrument with a
rubber head to test
reflexes
Tuning Fork

• A two-pronged metal
instrument used to test
reflexes
Cotton Applicator

• To obtain specimen
Gloves

• To protect the nurse

Tongue depressor

• To depress the
tongue during
assessment of the
mouth and pharynx
Sphygmomanometer
Pulse oximeter
Stethoscope
4 Primary techniques used
in physical examination

IPPA
 Inspection

Inspection is the visual examination, which is assessing by

using the sense of sight. Its should be deliberate, purposeful,
and systematic.
The nurse inspects with the naked eye. And with a lighted instrument such
as otoscope (used to view the ear). In addition to visual observations,
olfactory (smell) and auditory (hearing) cues are noted. Nurses frequently
used visual inspection to assess moisture, color, and texture of body
surfaces, as well as shape, position, size and symmetry of the body.
 Inspection

• Lighting must be sufficient for the nurse to see

clearly; either natural or artificial light can be
used. When using the auditory senses, it is
important to have a quiet environment for
accurate hearing. Inspection can be combined
with other assessment technique.
 Palpation

Is the examination of the body with 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 texture, temperature, vibration,
position, size, consistency, mobility of organs or masses
distention, pulsation and tenderness or pain.
 Types of Palpation

Light palpation (superficial)

Light palpation should always precede deep palpation because heavy

pressure on the finger tips can dull the sense of touch.

For light palpation, the nurse extends the dominant hand’s fingers
parallel to the skin surface and presses gently while moving the hand in
circle.
 Light palpation

• With light palpation, the skin is slightly

depressed. It is necessary to determine the
details of the mass, the nurse presses lightly
several times rather than holding the
pressure
Light palpation
 Deep palpation
• Deep palpation is done with two hands or one hand. In deep
bimanual palpation, the nurse extends the dominant hand as
for light palpation, then placed the finger pads of the non-
dominant hands on the dorsal surface of the distal
interphalangeal joint of the middle 3 finger of the dominant
hand. The top hand applies pressure to the lower hand, the
finger pads of the dominant hand press over the area to be
palpated.
 Deep palpation

• To test skin temperature, it is best to use the

dorsum (back) of the hand and fingers, where
examiner’s skin is thinnest.
• To test for vibration, the nurse should use the
palmar surface of the hand.
Deep palpation
 Deep palpation

Alert…
•Deep palpation is usually not done during a routine examination and
requires significant practitioner skill. it is performed with extreme
caution because pressure can damage internal organs. It is usually
not indicated in clients who had acute abdominal pain or pain that is
not yet diagnosed.
 Palpation
• The effectiveness of palpation depends largely on the client’s
relaxation. Nurses can assist client to relax by:
• Gowning and draping the client appropriately.
• Positioning the client comfortably.
• Ensuring that their hands are warm before beginning.
• During palpation the nurse should be sensitive to the client’s
verbal and facial expressions indicating our comfort.
 General guidelines for palpation:

The nurse’s hand should be clean and

warm, and the fingernails short.

Areas of tenderness should be palpated last.

Deep palpation should be done after

superficial palpation.
 Characteristic of Masses
• Location- site on the body, • Surface- smooth, nodular
dorsal/ventral surface
• Mobility- fixed, mobile
• Size- length and width in
centimeters • Pulsatility- present or
• Shape – oval, round, absent
elongated or irregular • Tenderness- degree of
• Consistency- soft, firm, hard tenderness to palpation
 Percussion

• The art of striking the

body surface to elicit
sounds that can be
heard or vibrations
that can be felt.
 Types of percussion

Direct percussion
• The nurse strikes the area to be
percussed directly with the pads of 2 or 3
or 4 fingers or with the pad of the middle
finger.
• The strikes are rapid, and the movement
is from the wrist. This technique is not
generally used to percuss the thorax but is
useful in percussing an adult’s sinuses
 Types of percussion

Indirect percussion
• The striking of an object (a finger)
held against the body area to be
examined.
• In this technique, the middle finger of
the nondominant hand, referred to as
pleximeter, is placed firmly on the
client’s skin.
 Indirect percussion
• Using the tip of the 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 remains
stationary. The angle between the plexor and the pleximeter
should be 90 decrees and the blows must be firm, rapid, and
short to obtain a clear sound.
 Indirect percussion

• Percussion is used to
determine the size and
the shape of internal
organs by establishing
their borders. It indicates
whether tissue is fluid
filled, air filled, or solid.
 Percussion elicit five types of sounds:

• Flatness- is extremely dull sound produced by very dense tissue such as

muscle or bone.
• Dullness- is a thud like sound produced by dense tissue such as the, liver,
spleen or heart.
• Resonance- is a hallow sound such as that produced by lungs filled with air.
• Hyperresonance- is not produced in the normal body. It is described as
booming and can be heard over an emphysematous lung.
• Tympany- is a musical or drum like sound from an air-filled stomach.
 Auscultation

• The process of listening to sounds produced with in the

body. Auscultation may be direct or indirect.
• Direct auscultation- is performed using the unaided ear.
• Indirect auscultation- is performed using a stethoscope,
which transmits sound to the nurse’s ears.
 Auscultation
• A stethoscope is used primarily to listen to sounds from
with in the body, such as lung sound, bowel sound or
valve sound sounds of the heart and blood pressure.
• The stethoscope tubing should be 30 to 35 cm (12 to
14 inches) long with an internal diameter of about 0.3
cm.
 Auscultation
• It should have both a flat disc diaphragm and a bell-
shaped amplifier.
• The diaphragm best transmits high-pitched sounds
(bronchial sounds) and the bell best transmits low pitched
sound such as some heart sounds.
• The ear pieces of the stethoscope should fit comfortably
into the nurse’s ear facing forward.