Objective Data Collection

• Objective data is the information that we gather using

the 5 senses. It is either a measurement or an
observation.
• Objective data gathered by measurement
-Temperature,BP, PR,RR, height, weight
* By observation
- Wound appearance, ambulation description
*By Physical Examination

PHYSICAL
EXAMINATION
PREPARATION :3
ASPECTS OF PREPARATION
– Physical setting, Oneself, Client
• Settings: Hospital room, OPD clinic, Doctor’s clinic,
School Health office, Employee Health office, Client’s
home
• GUIDELINES:
1. The room should be adequately ventilated,
comfortable, quiet, private & with adequate lighting.
2. Position the examining table so that both sides of
the patient are easily accessible.
3. The examination table should be at a height that
prevents the examiner from stooping and should be
equipped to raise the head up to 45 degrees.
4. A bedside stand or table should be available to lay
out all equipment needed

Preparation of Oneself
1. Assess your own feelings and anxieties before
examining the client.
2. Prevent transfer/transmission of infectious agents.
a. Wash hands before the examination
b. Always wear gloves if there is a chance that you
will use indirect contact with blood or other body fluids.
(examination of the mouth, an open wound,
genitalia, vagina or rectum) Change gloves when
moving from a contaminated to a clean body site and
between patients.
c. If a pin or sharp object is used to assess
perception, discard and use a new one for your next
client.
d. Wear a mask or protective goggles if you are
likely to be splashed with blood or body fluid droplets.
 Preparation of the
patient/client
1. Prepare patient physically and psychologically to allay
anxiety. Establish nurse-client relationship before the
examination.
2. Provide privacy to prevent feelings of
embarrassment. Curtain the unit as necessary.
3. Provide adequate information about the procedure
what toexpect and what is expected of the client.
4. Provide a new clean gown
5. Respect patient’s desire and request related to
Physical Examination.
6. Begin PE with the less intrusive procedure such as
measuring TPR BP, height , weight
7. It is useful to integrate health teaching & heath
promotion during the examination
8. Approach the client from the right hand side of the
examination table or bed.
9. Explain position changes during examination and why
it is necessary to ensure a thorough examination of
each body part and system.

General Guidelines in PE
1. Wash hands before the procedure
2. The general sequence of performing the technique of
PE is IPPA (Inspection, Palpation, Percussion,
Auscultation
3. Begin Pe by measuring height , weight, BP, TPR
 4. Explain each step in the examination and how patient
can cooperate. Encourage patient to ask questions.
5. Touch the patient’s hands. Check skin color, nail
beds, metacarpophalangeal joints. This is a less
threatening manner to ease a patient into being
touched.
6. Organize the steps of PE so the patient does not
change position too often.
7. Write out the examination sequence and refer to it as
needed or use a printed form of the procedure
8. Use a head to toe sequence.
9. The sequence of technique for examination of the
abdomen is as follows: IAPP (Inspection, Auscultation,
Percussion, Palpation)
10. During examination of the abdomen, flex the
patient’s knees to relax the abdominal muscles
11. The sequence of examining the quadrants of the
abdomen is as follows: RLQ, RUQ, LUQ,LLQ
12. Avoid abdominal palpation among patients with
tumor of the kidneys and liver.

General guidelines
13. Do auscultation of the abdomen for 5 minutes before
concluding absence of bowel sounds.
14. If ophthalmoscopy is done, darken the room for
better illumination. Explain this to the client.
15. If a female patient will be examined by a male nurse
or doctor, a female nurse must be in attendance. The
ideal situation is a female patient should be examined by
a female HCP.
 Techniques in Physical
Examination
• INSPECTION
– involves using the senses of vision, smell and
hearing to observe & detect any normal or
abnormal findings
– precedes PPA because the latter techniques can
potentially alter the appearance of what is being
inspected
– uses otoscope for ear examination and
ophthalmoscope for eye examination
– Guidelines:
• Make sure the room is comfortable

Guidelines in
Inspection
Look and observe before touching
Completely expose the body part you are inspecting
while draping the rest of the client as appropriate
Note the characteristics while inspecting for color,
patterns, size, location, consistency, symmetry,
movement, behavior, odors or sounds
Compare the appearance of symmetries of body parts
 PALPATION
• Consists of using parts of the hand to touch and feel
for the following characteristics:
texture (rough/smooth)
temperature (warm/cold)
moisture (dry/wet/moist)
mobility (fxed, movable, still, vibrating)
consistency (soft/hard/fluid-filled)
strength of pulses
(strong/weak/thready/bounding)
size (small/medium/large)
shape (well-efined/irregular)
degree of tenderness (minimal/
moderate/severe)

Different parts of the hand:

* finger pads- sensitive to fine discrimination,
pulses, texture,size, consistency,shape,crepitus
*ulnar/palmar surface-vibrations, thrills, fremitus
*dorsal/back surface- temperature

Types of Palpation
• depending on the depth of the structure being
palpated/thickness of the tissue underlying the
structures
• GUIDELINES:
Nails should be cut short
-hands should be a comfortable temperature
-Light Palpation
* to perform, place dominant hand lightly on the
surface of the structure to be examined. There
should be very little or no depression (<1cm)

Light Palpation
• feel the surface structure using a circular motion
• used for feeling pulses, tenderness, surface skin
texture, temperature, moisture

Moderate Palpation
• depress the skin 1-2cm (0.5-0.75 inch) with your
dominant hand & use a circular motion to feel for
easily palpable body organ or masses
• note size, consistency & mobility of structures you
palpate

Deep Palpation
• Place your dominant hand on the skin surface and
your non-dominant hand on top of your dominant
hand to apply pressure
• This should result in a surface depression between
2.5- 5cm (1-2 inch)
• This allows to palpate/feel very deep organs or
structures that are covered by thick muscles.
 Bimanual Palpation
• Uses both hands to hold and feel a body structure
• Use the 2 hands, pacing one on each side of the
body part (uterus, breast, spleen) being palpated
• Use one hand to apply pressure & the other hand to
feel the structure
• Note the size, shape, consistency & mobility of the
structure you palpate

PERCUSSION
• involves tapping body parts to produce sound waves
• these sound waves or vibrations enable the
examiner to assess underlying structures
• Uses of Percussion
– elicit pain
– determine location, size, and shape
– determine density
– determine abnormal masses
* percusion vibrations penetrate approx 5cm deep
* deep masses don’t produce any change in the
normal percussion vibration
– elicit reflexes
– deep tendon reflexes (DTR) are elicited using
percussion hammer
– 3 Types of Percussion
*1. Direct- tapping of a body part with one or 2
fingertips to elicit possible tenderness
*2. Blunt- used to detect tenderness over organs
(kidneys) by placing one hand flat on the body
surface & using the fist of the other hand to strike
the back of the hand fat on the body surface
3. Indirect or mediate percussion- most commonly
used method of percussion. The tapping down with
this type produces sound or tone that varies with
the density of the underlying structures.
*As the density increases, the sound of the tone
become quieter.
* soft tissue produces soft tone
* fluid tissue produces louder tone
* air produces even louder tone
*These tones are referred to as percussion notes
and are classified according to organ, quality,
intensity and pitch
 Classification of
Percussion notes
Sound Intensity Pitch Length Quality Organ
1.
Resonance loud low long hollow Normal
heard over lung
part air &
part solid

2. Hyper- very loud low long booming

resonance Lung
heard over with
mostly air Emphys
loud high moderat drum- ema
3. Tympany e like
heard over Puffed-
air out
cheek
Gastric
bubbles

Sound Intensity Pitch Length Quality Organ

4.
Dullness medium medium moderat Thud- Liver
heard e like Diaphrag
over m
more PE
solid
tissue soft high Muscle
short flat Bone
5. Sternum
Flatness Thigh
heard
over
dnse
tissue

Percussion Technique
guideline
• Place the middle finger finger of your non-dominant
on the body part you’re going to percuss
• Keep your other fingers off the body part being
percussed to avoid damping the elicited tone
• Use the pad of your middle finger of the other hand
to strike the middle finger of the other hand (non-
dominant) on the body part
• Withdraw your finger immediately to avoid damping
the tone

• Deliver 2 quick taps and listen carefully to the tone

• Use quick, sharp taps by quickly flexing your wrist
not your forearm

AUSCULTATION
• requires the use of a stethoscope to listen for heart
 sounds, movement of blood through the CVS,
movement of the bowel & movement of air
throughthe respiratory tract
• the sounds are not audible to the human ear
• the sound detected are classified according to
– intensity (loud/soft)
– pitch (high/low)
– duration (length)
– quality ( musical, crackling, raspy sound)

Auscultation guidelines
• Eliminate distracting or competing noises from the
environment
• Expose the body part to be auscultated
• Do not auscultate through the client's clothing or
gown
• Use the diaphragm to listen for high-pitch sounds
such as a normal heart sounds, breath sounds and
bowel sounds and press firmly the diaphragm in the
part being auscultated
• Use the bell to listen for pitched sounds such as
abnormal heart sounds & bruits
 DIAGNOSTIC
STUDIES/PROCEDURE
S
• are examinations to identify an individual’s specific
areas of weakness and strength in order to
determine a condition, disease or illness
• Examples: blood sample, biopsy, colonoscopy