CHAPTER 1

PRELIMINARY

1.1 Background

Physical examination or clinical examination is a process by which a medical

professional examines the patient's body for clinical signs of disease. The results of the
examination will be recorded in the medical record. Medical records and physical
examinations will assist in diagnosis and planning for patient care.

Usually, physical examination is carried out systematically, starting with the head and
ending at the limbs. After the main organ examination is examined by inspection, palpation,
percussion, and auscultation, some special tests may be required such as a neurological test.

With clues obtained during the history and physical examination, the medical
professional can come up with a differential diagnosis, a list of possible causes for the
symptoms. Several tests will be done to confirm the cause.

1.2 Problem Formulation

1. What is meant by physical examination?

2. What are the techniques or methods used in the physical examination?

3. What are the vital signs and how are they checked?

4. What is meant by head to toe?

1.3 Purpose of Writing

1. To find out what is called a physical examination.

2. To find out what are the techniques or methods of physical examination.

3. To find out what includes vital signs and how to check vital signs.

4. To find out what is a head to toe check and how to check head to toe.

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 CHAPTER 2

DISCUSSION

2.1 PHYSICAL EXAMINATION

The physical examination is a head-to-toe review of each body system that provides
objective information about the client and allows the nurse to make a clinical assessment. The
accuracy of the physical examination affects the choice of therapy received by the client and
the determination of the response to the therapy (Potter and Perry, 2005).

The definition of Physical Examination recruiting experts includes:

1. Physical examination is a head-to-toe review of each body system that provides objective
information about the client and allows the nurse to make a clinical assessment. The accuracy
of the physical examination affects the choice of therapy received by the client and the
determination of the response to the therapy. (Potter and Perry, 2005).

2. Physical examination dalah examination of the client's body as a whole or only certain
parts that are deemed necessary, to obtain systemative and comprehensive data, ensure /
prove the results of the history, determine problems and plan appropriate nursing actions for
clients. (Dewi Sartika, 2010).

3. Physical examination is an examination of the body to determine any abnormalities of a

system or an organ of the body by seeing (inspection), feeling (palpation), tapping
(percussion) and listening (auscultation). (Raylene M Rospond, 2009; Terj D. Lyrawati,
2009).

2.2 Purpose and Benefits of Physical Examination

1. Purpose of Physical Examination

In general, the physical examination is carried out for the following purposes:

a. To collect basic data about client health.

b. To add to, confirm, or refute data obtained in the nursing history.

c. To confirm and identify nursing diagnoses.

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d. To make a clinical assessment of changes in the client's health status and management.

e. to evaluate the physiological outcome of care.

2. Benefits of Physical Examination

Physical examination is an examination of the client's body as a whole or only certain

parts that are deemed necessary, to obtain systemative and comprehensive data, ensure /
prove the results of the history, determine problems and plan appropriate nursing actions for
clients. (Dewi Sartika, 2010)

Purpose of Physical Examination

• To collect basic data about client health.

• To add, confirm, or refute data obtained in the nursing history.

• To confirm and identify nursing diagnoses.

• To make a clinical assessment of changes in the client's health status and management.

• To evaluate the physiological outcome of care.

However, each examination also has specific objectives which will be explained later in each
part of the body that will be subjected to a physical examination.

BENEFITS OF PHYSICAL EXAMINATION

Physical examinations have many benefits, both for nurses themselves and for other
health professionals, including:

• As data to assist nurses in establishing nursing diagnoses.

• Knowing the client's health problems.

• As a basis for selecting appropriate nursing interventions

• As data to evaluate the results of nursing care

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2.3 PHYSICAL EXAMINATION TECHNIQUES

There are 4 techniques in physical examination, namely:

1. Inspection

Inspection is an examination using the senses of sight, hearing and smell. General
inspection is done when you first meet the patient. A general description or impression about
the state of health that is formed. The examination then advances to a local inspection which
focuses on a single system or part and usually uses specialized tools such as an
optalomoscope, otoscope, speculum and others. (Laura A. Talbot and Mary Meyers, 1997)

Inspection is an examination carried out by looking at the part of the body being examined
through observation (eye or a magnifying glass). (Dewi Sartika, 2010)

The focus of inspection on each part of the body includes: body size, color, shape, position,
symmetry, lesions, and protrusions / swelling. After inspection it is necessary to compare the
normal and abnormal results of one body part with another. Example: yellow eyes (jaundice),
there is a goitre in the neck, bluish skin (cyanosis), and others.

2. Palpation

Palpation is an examination using the sense of touch by placing the hand on the part of the
body that can be reached by the hand. Laura A. Talbot and Mary Meyers, 1997). Palpation is
an examination technique that uses the sense of touch; hands and fingers, to determine the
characteristics of tissues or organs such as: temperature, elasticity, shape, size, humidity and
protrusion (Dewi Sartika, 2010).

The things detected are temperature, humidity, texture, motion, vibration, growth or mass,
edema, crepitus and sensation. Steps that need to be considered during palpation:

• Create a comfortable and relaxing environment.

• The nurse's hands should be warm and dry

• The nurse's fingernails should be cut short.

• All the painful parts are palpated last.

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For example: a tumor, edema, crepitus (fracture), and others.

3. Percussion

Percussion is an examination that includes tapping the surface of the body to produce sound
that will assist in determining the density, location, and position of the structure underneath
(Laura A. Talbot and Mary Meyers, 1997).

Percussion is an examination by tapping a certain part of the body surface to compare it with
other parts of the body (left / right) by producing sound, which aims to identify boundaries /
locations and tissue consistency. (Dewi Sartika, 2010). The sounds found on percussion are:

• Sonor: normal tissue percussion sound.

• Dim: percussion sound of denser tissue, for example in the lung area in pneumonia.

• Deafness: dense tissue percussion sound such as heart area percussion, liver area
percussion.

• Hypersonic / tympanic: percussion sound in a more hollow hollow area, for example the
caverna area of the lungs, in chronic asthma clients.

4. Auscultation

Auscultation is the act of listening to sounds generated by various organs and tissues (Laura
A. Talbot and Mary Meyers, 1997). Auscultation Is a physical examination done by listening
to the sounds produced by the body. Usually using a tool called a stethoscope. The things that
are listened to are: heart sounds, breath sounds, and bowel sounds (Dewi Sartika, 2010).

Abnormal sounds that can be auscultated on the breath are:

• Rales: the sound produced from a sticky exudate as the fine airways expand on inspiration
(fine, moderate, coarse rales). For example in clients with pneumonia, tuberculosis.

• Ronchi: low and very harsh notes heard both on inspiration and on expiration. The
characteristic of Ronchi is that it will disappear when the client coughs. For example, in
pulmonary edema.

• Wheezing: a sound that sounds “ngiii… .k”. can be found in the inspiration and expiration
phases. For example, in acute bronchitis, asthma.

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• Pleura Friction Rub; a sound that sounds "dry" like the sound of sandpaper rubbing against
wood. For example, in clients with pleural inflammation.

The physical assessment approach can use:

1. Head to toe (head to toe) This approach is carried out from the head and sequentially down
to the feet. Starting from: general condition, vital signs, head, face, eyes, ears, nose, mouth
and throat, neck, chest, lungs, heart, abdomen, kidneys, back, genetalia, rectum, extremity.

2. ROS (Review of System / body system)

The assessments carried out cover all body systems, namely: general condition, vital signs,
respiratory system, cardiovascular system, nervous system, urinary system, digestive system,
musculoskeletal system and integument, reproductive system. The information obtained helps
nurses determine which body systems need special attention.

3. Patterns of health function Gordon, 1982

The nurse collects data systematically by evaluating patterns of health function and focusing
physical assessment on specific problems including: perceptions of health-health
management, nutrition-metabolic patterns, elimination patterns, sleep-rest patterns, cognitive-
perceptual patterns, role-related patterns, activity- exercise patterns, sexuality-reproductive
patterns, coping-stress tolerance patterns, values-belief patterns.

In carrying out a physical examination, there are principles that must be considered, namely
as follows:

• Infection control

This includes washing hands, putting on sterile gloves, putting on masks, and helping clients
wear check clothes if any.

• Environmental controls

Namely, ensuring the room is comfortable, warm, and sufficiently lit to carry out a physical
examination for both the client and the examiner himself. For example, closing the door /
window or skerem to maintain client privacy.

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• Communication (explanation of procedures)

• Client privacy and comfort

Systematic and consistent (head to toe, from external to internal, dr normal to abN)

• Be on the client's right side

• Efficiency

• Documentation

VITAL SIGNS EXAMINATION

A. Pulse Examination

Pulse is the pulse or impulse that is felt from the pumping process of the heart. The pulse
examination should be carried out in a sleep or resting state. Hyperthermia conditions can
increase the pulse as much as 15-20 times per minute every 1 degree Celsius increase in
temperature.

Other pulse assessments are sinus tachycardia which is characterized by a variation of 10-15
beats from minute to minute and paroximal supraventricular tachycardia characterized by
difficult pulse counting because it is too fast (more than 200 beats per minute) .Bradicardia is
a heart rate frequency slower than normal. . Another pulse check is the rhythm, normal or not.
Sinus dysrhythmias (arrhythmias) are pulse irregularities, the pulse being faster on inspiration
and slower on expiration.

B. Blood Pressure Check

Blood pressure examination is an important indicator in assessing cardiovascular function. In

the process, changes in blood pressure are influenced by various factors, including;

1. Peripheral Repulsion. Is a circulatory system that has the highest pressure system (arteria)
and the lowest pressure system (capillaries and veins), between the two there are arterioles
and very fine muscle vessels.

2. The pumping motion of the heart. The more blood that is pumped into the arteries, the
more bloated the arteries will cause an increase in blood pressure. Likewise the opposite.

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3. Blood volume. Increased blood causes greater pressure on the arteries.

4. Blood viscosity. This blood viscosity depends on the ratio of blood cells to plasma.

C. Breathing Examination

Is an examination done to assess the process of taking oxygen and removing carbon dioxide.
Assess the frequency, rhythm, depth and type or pattern of breathing

D. Check temperature

Temperature checks are used to assess metabolic conditions in the body, where the body
produces heat chemically through blood metabolism. The temperature balance must be
regulated in the disposal and storage in the body which is regulated by the hypothalamus.
Heat removal or discharge can occur through various processes, including;

1. Radiation, namely the process of spreading heat through electromagnetic waves.

2. Convection, namely the process of spreading heat due to a shift between areas whose
density is not the same as that of the body in moving cold air or swimming pool water.

3. Evaporation, namely the process of changing liquid into steam.

4. Conduction, which is the process of transferring heat to another object by direct contact
without obvious movement, such as contact with cold surfaces and others.

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 CHAPTER 3

CLOSING

CONCLUSION

Physical examination is an examination of the client's body as a whole or only certain parts
that are deemed necessary, to obtain systemative and comprehensive data, ensure / prove the
results of the history, determine problems and plan appropriate nursing actions for clients.

Absolute physical examination is carried out on each client, especially for clients who have
just entered the health service to be treated, regularly on clients who are being treated, at any
time according to client needs. So this physical examination is very important and must be
done in these conditions, both the client is conscious and unconscious. Physical examination
is very important because it is very useful, both for establishing nursing diagnoses, selecting
appropriate interventions for the nursing process, and for evaluating the results of nursing
care.

Suggestion

In order for the physical examination to be carried out properly, the nurse must understand
the science of the physical examination perfectly and this physical examination must be
carried out sequentially, systematically, and carried out with the correct procedure

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