PRINCIPLES
OF THE PHYSICAL EXAMINATION
·
Compare both sides of
body for symmetry
·
First assess the system
which is at risk e.g. chest pain asses’ cardiovascular assessment
·
If fatigue give rest
periods between assessment
·
Painful procedure at end
·
Record quick notes during
examination
General survey
Exam begins the minute you first see the patient
Exam continues throughout your patient interaction
Observation is a wealth of information
Stature, Health status, Weight, Personal hygiene, Skincolour/lesions,
Breath/odor, Mood/attitude
Techniques of the
physical examination
·
Inspection
·
Palpation
·
Percussion
·
Auscultation
·
Olfaction
Visual inspection
·
Inspect carefully all
areas of exam
·
Document both normal and
abnormal findings
·
Visual examination by
using the sense of sight.
·
It should be deliberate,
purposeful, and systematic.
·
The nurse inspects with
the naked eye and with a lighted instrument
Inspection is used
- to assess moisture,
ü colour
ü texture
of the body surfaces
ü shape
ü Position
ü size
ü colour
ü Symmetry
of the body.
Palpation
ü texture
ü size
ü consistency
ü crepitus
ü temperature
ü Masses
ü Vibration
ü Position
ü Pulsation
Part used in
palpation
·
Palmar surface of hand –
determine position, texture, size, mass, crepitus
·
Dorsal surface of back- to
check body temperature
·
Fingers- vibration
Palpation - the
examination of the body using the sense of touch
The pads of the fingers are used -concentration of
nerve endings makes them highly sensitive to tactile discrimination.
Two types of
palpation: light and deep.
Light
(superficial) palpation should always precede
deep palpation
Light palpation- dominant hand's fingers parallel to
the skin surface presses gently while moving the hand.
Deep palpation
is done with two hands (bimanually) or one hand.
Depress 4cm depth
Deep Palpation- deep palpation is done with 2
hands/one hand , in deep bimanual palpation, extend the dominant hand like
light palpation, the place the finger pads of the non-dominant hand on the
dorsal surface of the distal interphalangeal joint of the middle 3 fingers of
the dominant hand . Top hand applies pressure while lower hand remains relaxed
to perceive tactile sensation. It is done with extreme caution because pressure
can damage internal organs.
General guidelines
for palpation
·
The nurse's hands should
be clean and warm, and the fingernails short.
·
Areas of tenderness
should be palpated last.
·
Deep palpation should be
done after superficial palpation
·
Client should be relaxed
– gowning, draping, comfortable positioning, and warm hands & be sensitive
to client’s verbal & facial expressions indicating discomfort
Characteristics of
masses
|
Location
|
Site on the body, dorsal/ventral surface
|
|
size
|
Length and width in centimeters
|
|
Shape
|
Oval, round, elongated, irregular
|
|
Consistency
|
Soft, firm, hard
|
|
surface
|
Smooth, nodular
|
|
Mobility
|
Fixed /mobile
|
|
Pulsatility
|
Present/absent
|
|
Tenderness
|
Degree of tenderness to palpation
|
PERCUSSION
Use of the hands and fingers. Striking one object
against another
The act of striking the body surface to elicit sounds
Two types of
percussion: direct and indirect.
The strikes are rapid, and the movement is from the
wrist
2.
Indirect, mediate, or finger percussion -is striking a finger of one hand on a
finger of the other hand as it is placed over an organ to determine the size
and shape of internal organs by establishing their borders.
Percussion elicits
five types of sound: flatness, dullness,
resonance, hyperresonance, and tympany
Flatness - muscle or bone.
Dullness - liver, spleen, or heart.
Resonance - lungs filled with air. Hyperresonance - emphysematous
lung.
Tympany - air-filled stomach
|
Sound
|
Intensity
|
Pitch
|
Duration
|
Quality
|
e.g. of Location
|
|
Flatness
|
Soft loud
|
High
|
Short
|
Extremely dull
|
Muscle, bone
|
|
Dullness
|
Medium
|
Medium
|
Moderate
|
Thud like
|
Liver, heart
|
|
Resonance
|
Loud
|
Low
|
Long
|
hollow
|
Normal lung
|
|
Hyper resonance
|
Very loud
|
Very low
|
Very long
|
Booming
|
Emphysematous
|
|
tympany
|
loud
|
High(distinguished By musical timbre)
|
moderate
|
musical
|
Stomach filled with gas
|
Auscultation
·
Listening for sounds
produced within the body
·
blood pressure,
intestinal sounds
·
Auscultation may be
direct or indirect.
·
Direct auscultation is
the use of the unaided ear
·
Indirect auscultation is
the use of a stethoscope
Olfaction:
·
Assessing patient with
source of body odour
·
Using a sense of smell
·
Body and breath odour
·
To identify the various
diseases/complications-fruity ketone smell from oral cavity in diabetic
ketoacidosis
Physical
examination
·
Minutes to hours to
perform
·
Observation to hands on
·
Continue throughout the
entire care of the patient
·
Systematic and thorough
COMMENTS