Principles of Physical Examination

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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

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notes.nursium.com: Principles of Physical Examination
Principles of Physical Examination
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