Collecting Objective Data: The
Physical Examination
To be proficient with physical
assessment skills, the nurse must
have basic knowledge in three areas:
1. Types and operation of
equipment
2. Preparation of the setting,
oneself, and the client
3. Performance of the four
assessment techniques: IPPA
Equipment
• Prior to the examination, prepare
the necessary equipment to
promote organization and
prevents the nurse from leaving
the client
Skinfold calipers Penlight
Otoscope Tuning fork
Doppler ultrasound device Reflex hammer
Goniometer Vaginal speculum
Preparing for the Examination
•Preparation of the physical
setting, yourself, and the
client affect the quality of
the data you elicit.
Preparing the Physical Setting
The following conditions must be meet:
• Comfortable, warm temperature (blanket)
• Private area free of interruption from others
• Quiet area free of distractions
• Adequate lighting
• Firm examination table or bed at a height that prevents
stooping
• A bedside table/ tray to hold equipment
Preparing Oneself
•Assess your own feelings and anxieties
•Achieve self-confidence
•Prevent transmission of infectious agents
General Principle to keep in mind when
performing Physical Assessment
• Wash hands before beginning the examination, immediately after
accidental direct contact with blood of other body fluids, and after
completing the physical examination or after removing gloves.
• Always wear gloves if there is a chance that you will come in
contact with blood or other body fluids or if you have an open cut
or abrasions. Change between clients.
• If a pin or sharp object is used to assess sensory perception,
discard the pin and use new one for your next client
• Wear a mask and protective goggles if there is a possibility of
splashes of blood and other body fluids droplets (oral examination
of client with productive cough).
Approaching and Preparing the Client
• Establish a nurse-patient relationship
• Respect the client’s desires and requests
• Let the client to undress and put on an examination gown
• Begin the examination with the less intrusive procedures
• Approach the client from the right-hand side of the
examination table or bed
Physical Examination Techniques
•Inspection
•Palpation
•Percussion
•Auscultation
Inspection
•Involves using the senses of vision, smell,
and hearing to observe and detect any
normal or abnormal findings.
•Usually precedes PPA
Guidelines in Performing Inspection
• Make sure the room has a comfortable temperature
• Use good lighting, preferably sunlight
• Look and observe before touching
• Completely expose the body part you are inspecting while draping
the rest of the client as appropriate
• Note the following characteristics: color, pattern, size, location,
consistency, symmetry, movement, behavior, odors, or sounds
Palpation
• Consist of using parts of the hand to touch and feel for the following characteristics:
• Texture (smooth/rough)
• Temperature (worm/ 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
Guidelines in Performing Palpation
•Examiner’s fingernails should be short and
the hands should be a comfortable
temperature.
•Start form light, to moderate, and finally to
deep palpation.
Parts of the hands to use when palpating
Hand part Sensitive to
Finger pads Fine discriminations: pulses, texture, size,
consistency, shape, crepitus
Ulnar or palmar Vibrations, thrills, fremitus
surface
Dorsal (back) Temperature
surface
Four types of Palpation
Light palpation Moderate palpation Deep palpation Bimanual palpation
• Place dominant • 1 to 2 cm • 2.5 to 5 cm • Place one hand on
hand lightly with depression depression each side of the
little or no • Note the size, • Put your body parts (uterus,
depression (less consistency, and nondominant hand breasts, spleen)
than 1cm) mobility of on top of the being palpated
• Pulses, structures you dominant hand • Note the size,
tenderness, palpate • Allows you to feel shape,
surface skin deep organs or consistency, and
texture, structures mobility of the
temperature, and structures
moisture
Percussion
• Involves tapping body parts to produce sound
waves or vibrations to assess the underlying
structures.
Uses of Percussion
• Eliciting pain- inflamed underlying structure
• Determining location, size, and shape
• Determining density- whether filled with air or fluid
• Detecting abnormal masses
• Eliciting reflexes
Types of percussion
• Direct percussion
• Directly tapping with one or two fingertips to elicit possible
tenderness (sinusitis)
• Blunt percussion
• Determine tenderness over organs (kidneys) by placing one hand flat
on the body surface and striking it with a fist hand
• Indirect percussion
• Most commonly used method to determine the density of the
underlying structure
• As density increases, the sound of the tone becomes quieter
(referred to as the percussion notes)
Auscultation
• Is an assessment technique that requires the use of a
stethoscope to listen for heart sounds, movement of
the blood, movement of the bowel, and movement of
air through the respiratory tract.
Guidelines to practice when performing
auscultation
• Eliminate distracting or competing noises
• Expose the body part (clothing causes rubbing)
• Use the diaphragm of the stethoscope to listen to high-
pitched sounds, such as normal heart sound, breath sounds,
and bowel sounds, and press the diaphragm firmly
• Use the bell of the stethoscope to listen for low-pitched
sounds such as abnormal heart sounds and bruits (blowing or
murmuring sound)
Do’s and Don’ts when
using stethoscope
• Warm the diaphragm or bell
before placing it on the client’s
skin
• Explain what you are listening for
• Do not apply too much pressure
when using the bell
• Avoid listening through clothing,
which may obscure or alter
sounds
Thank you…
