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unit 2

The document outlines the basic techniques of physical examination, including inspection, palpation, percussion, and auscultation, emphasizing their importance in assessing objective data. It details the sequence of examination, techniques for each method, and the necessary equipment for effective health assessment. Key points include the systematic approach to minimize patient discomfort and maximize examiner efficiency.

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12 views

unit 2

The document outlines the basic techniques of physical examination, including inspection, palpation, percussion, and auscultation, emphasizing their importance in assessing objective data. It details the sequence of examination, techniques for each method, and the necessary equipment for effective health assessment. Key points include the systematic approach to minimize patient discomfort and maximize examiner efficiency.

Uploaded by

yaregaladmasu8
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Unit II - Physical Examination

Objectives
 Discuss basic techniques of physical
examination
 Objective data, the signs perceived by the
examiner are assessed through the physical
examination.
 The skills or art used for physical assessment
include inspection, palpation, percussion and
auscultation.
Sequence of physical examination

 Sequence of physical examination is


designed to:-
• Minimize changing position of the patient
• Maximize the examiners efficacy
• It is helpful to move from head to toe.
• The examiners position for supine patient is
better examined by right side.
Basic techniques of physical examination

1. Inspection
 It is concentrated watching.
 It always comes first than the other techniques.
 Helps to compare the right and left sides of the
body and to confirm that the two sides are
nearly symmetric.
Basic techniques cont’d
 Inspection requires good lighting, adequate
exposure, and occasional use of certain
instruments (otoscope, ophthalmoscope and
penlight) to enlarge your view.
 During inspection expose only the necessary
part that needs inspection.
Basic techniques cont’d

2. Palpation
 It is touching and feeling body parts with
hands.
 It follows and often confirms points you noted
during inspection.
 It applies your sense of touch to assess texture,
temperature, moisture, organ location and size,
as well as any swelling, pulsation, rigidity,
presence of lumps or masses and presence of
tenderness and pain.
 Different parts of the hands are best suited for
assessing different factors:
 Fingertips best for fine tactile discrimination,
such as skin texture, swelling, pulsatility, and
determining presence of lumps.
 A grasping action of the fingers- to detect the
position, shape and consistency of an organ or
mass.
 The dorsa (backs) of hand and fingers-best for
determining temperature because the skin here
is thinner than on the palms.
 Base of the fingers or lunar surface of hand –to
detect vibration.
 Your palpation technique should be slow and
systematic.
 Warm your hands by kneading them.
 Palpate tender areas last.
 Start with light palpation to detect surface
characteristics and accustom the person to be
touched.
 Then perform deeper palpation through deep
breathing.
 Bimanual palpation requires the use of both your
hands to capture certain organs such as kidneys,
uterus.
• Types of palpation
 Light
 Deep
 Bimanual
3. Percussion
 Is tapping the person’s skin with short, sharp
strokes in order to assess the underlying
structures.
 The strokes yield a palpable vibration and a
characteristic sound that show the location,
size and density of the underlying organ.
• Purpose of percussion:-
• Mapping out the location and size of an organ
by exploring where the percussion note
changes between the borders of an organ and
its neighbors.
• Signaling the density (air, fluid, or solid) of a
structure.
 Detecting an abnormal mass if it is fairly
superficial.
 The percussion vibration penetrates about 5cm
deep. A deeper mass would give no change in
percussion.
 Eliciting pain if the underlying structure is
inflamed, as with the sinus areas or over the
kidney.
 Eliciting a deep tendon reflex using the
percussion hammer.
– There are two methods of percussion
direct and indirect.
1. Direct percussion
 The striking hand directly contacts the body
wall.
 Eg. in infant’s thorax or the adult’s sinus
areas
2. Indirect percussion
 It is used more often, and involves both hands.
 The striking hand contacts the stationary hand
fixed on the person’s skin.
 Place the middle finger of the non-dominant
hand firmly over the area being examined.
 It is important to keep the other fingers and the
palm of the hand raised to avoid contact with
the body surface, because pressure from other
fingers and palm muffles the tones.
 Next, position the forearm of the dominant
hand close to the body surface.
 Using only the wrist of the dominant hand to
generate the motion,
 Bring the middle fingertip of the dominant
hand down to the finger at the inter-phalangeal
joint, and immediately back up again.
 If the striking finger remains against the
“drum” finger, the sound waves are muffled.
Indirect fist percussion-
 Put your hands on the area and indirectly tap
with fist.
 It is used to detect tenderness.
 Percussion by percussion hammer is used to
observe the reflex.
• Sounds produced during percussion
 Flat sound- no air or fluid (percussion on
muscle bone)
 Resonant- normal lung sound (high pitch), air
 Hyper resonant - children’s lung during direct
percussion
 Dull- no air (percussion on liver, spleen,
heart)
• N.B:- Do not percuss on the bone and breast.
4. Auscultation
 Is listening to sounds produced by the body
such as, the heart and B/P, the lungs and
abdomen by using stethoscope.
 a stethoscope with two-end pieces- a
diaphragm and a bell.
 Diaphragm is used mostly, because its flat
edge is best for high pitched sounds-(breath,
bowel and normal heart sounds).
 Hold the diaphragm firmly against the person’s
skin, firm enough to leave a slight ring
afterward.
 The bell end piece has a deep hollow cuplike
shape.
 It is best for the soft low- pitched sounds such
as extra heart sounds or murmurs.
Production of sound-
All sound results from the vibration of some
structure.
Percussing over a body structure causes
vibrations that produce characteristic waves
and are heard as percussion notes.
1. Amplitude (or intensity) - a loud or soft
sound.
 The louder the sound, the greater the
amplitude.
 Loudness depends on the force of the blow
and the structures ability to vibrate.
2. Pitch (or frequency)
 The number of vibrations per second
 More rapid vibrations produce a high pitched
tone; slower vibrations yield a low- pitched
tone.
3. Duration- the length of time the note lingers.
Equipments needed for health
Assessment

– Sphygmomanometer
– Stethoscope with bell and diaphragm end
piece
– Thermometer
– Flashlight or penlight
– Otoscope/ ophthalmoscope
– Tuning fork
– Nasal speculum
– Tongue depressor
– Skin marking pen
– Flexible tape measure
– Reflex hammer
– Sharp objective (sterile needle)
– Cotton balls
– Bivalve vaginal speculum
– Clean gloves
– Lubricant
THANK YOU !!!

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