27-Nov-24

Theoretical Lec. Second lectures

2024-2025

Learning outcomes

After completing this Lecture , you will be able to:

1. Identify the purposes of the physical examination.

2. Explain the four methods used in physical examination.

3. Explain the significance of selected physical findings.

4. Identify expected outcomes of health assessment.

5. Identify the steps in selected examination procedures.

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Assessing a client's health status is a major component of nursing care

Physical health assessment

A complete health assessment may be conducted starting at the,

head and proceeding in a systematic manner downward (head to-
toe assessment).

Assessment Techniques
To make your head-to-toe assessment systematic, you need to know
about the four basic assessment techniques. These techniques are
inspection, palpation, percussion, and auscultation.
Inspection:
involves using the senses of vision, smell, and hearing to
observe and detect any normal or abnormal findings.

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•Palpation consists of using parts of the hand to touch and feel for the
following characteristics: texture, temperature, moisture, mobility, consistency,
the strength of pulses, size, shape, and degree of tenderness.

•Percussion involves tapping body parts to produce sound waves. These

sound waves or vibrations enable the examiner to assess underlying structures.

•Auscultation involves 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.

purposes of the physical examination

1. To Identify the client's functional abilities

2. To confirm the data obtained in the nursing history.

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

4. To evaluate the physiologic outcomes of health care and thus the progress

of a client's health problem

5. To make clinical judgments about a client's health status.

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Preparation for Examination

1. Infection control.
2. Environment.
3. Equipment.
4. Physical preparation of patient ( Positioning)
5. Psychological preparation of patient.
6. Assessment of age groups.

Organization of the Examination

1. Assessment of each body system

2. Systematic and organized , Head-to-toe approach.

3. Compare sides for symmetry.

4. Be specific when recording assessments

5. Record quick notes during the examination

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Methods of Examining

Four primary techniques are used in the physical examination:

1. Inspection

2. Palpation

3. Percussion

4. Auscultation

1-Inspection

Inspection is the visual examination, that is, assessing by using the sense of sight.

sound, and smell to assess a patient.

Nurses frequently use visual inspection to assess the moisture, color, and texture

of body surfaces, as well as the shape, position, size, color, and symmetry of the

body.

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The following table highlights areas of interest that should always be

inspected during a physical assessment.
Observation Relevance

Skin colour Pink skin may result from allergy , blue skin can be indicative of hypoxia

Symmetry Asymmetrical face, chest, or limbs may indicate a more serious problem

Foul Odor May be indicative of infection or dietary upset

The digestive system, respiratory system, and cardiovascular systems may

Unusual sound
produce unusual sounds when function is compromised

2-Palpation is used to determine

• Temperature (e.g., of a skin area)

• Position, size, and mobility of organs or masses
• Distention (e.g., of the urinary bladder)
• Pulsation; and presence of pain upon pressure.

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There are two types of palpation:

• Light (superficial) palpation should always precede deep palpation.
• Deep palpation is done with two hands (manually) or one hand.
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.

Light palpation

Deep palpation

Light palpation

General guidelines for palpation include the following:

1. The nurse's hands should be clean and warm, and the fingernail short.

2. Areas of tenderness should be palpated last.

3. Deep palpation should be done after superficial palpation

4. Uses touch to gather information.

5. Use different parts of hands to detect different characteristics.

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3-Percussion

Involves tapping body parts to produce sound waves. These sound

waves or vibrations enable the examiner to assess underlying
structures.
• There are two types of percussion:
Direct and indirect.
In Indirect 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.

• 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.
Percussion elicits five types of sound:

• Flatness :
is an 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.

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• Resonance :
Is a hollow sound such as that produced by lungs filled with air.
• Hyper resonance :
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 produced from an air-filled stomach

4-Auscultation

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

Auscultation may be direct or indirect.

Direct auscultation:
Is the use of the unaided ear, for example, to listen to a
respiratory wheeze or the grating of a moving joint.

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Indirect auscultation:
Is the use of a stethoscope, which transmits the 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 respiratory sound
,blood pressure.

Respiratory sound areas

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After the Examination

1. Record findings.

2. Give the patient time to dress; assist if needed.

3. If findings are serious, consult health care provider before informing

the patient.

4. cleaning of the examination area.

5. Record complete assessment; review for accuracy.

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