Collecting Objective Data

(Physical Examination)
NCM 101 Health Assessment
1st Semester, AY 2020-2021
 Learning objectives:
At the end of the session, the students will be able to:
1. Define an objective data
2. Differentiate the four assessment techniques:
a. Inspection
b. Palpation
c. Percussion
d. Auscultation
3. Properly perform and apply assessment techniques
4. Recognize the importance of proper assessment techniques in
identifying health problems.
Objective data
● An objective data includes information about the client that is
directly observed during interaction with the client.
● Information elicited through physical assessment techniques.
● To be able to properly obtain an accurate physical assessment, a
nurse must have knowledge in three basic areas:

1. Types and operation of equipment needed for a particular

examination
2. Preparation of the setting, oneself, and the client for the physical
assessment
3. Performance of the four assessment techniques
Physical Assessment: Indications

• Routine screening

• Eligibility prerequisite for health insurance,

military service, job, sports, school

• Admission to a hospital or long term care

facility
 Physical Assessment: Points To Remember

 Reviewing general information

 Introduction to client

 Obtaining the health history

 Pain assessment

 This is key to holistic approach

EQUIPMENT USED DURING A PHYSICAL Assessment
All examination Gloves and Gown
Vital signs Sphygmomanometer
Stethoscope
Thermometer
Watch with second hand
Pain rating scale
Nutritional status examination Skin fold calipers
Tape measure
Skin marking pen
Weighing scale with height attachment
Skin, hair, and nail examination Penlight
Mirror
Metric ruler
Magnifying glass
Wood’s light
Braden scale
Pressure ulcer scale for healing
 EQUIPMENT USED DURING A PHYSICAL Assessment

Head and neck examination Stethoscope

Small cup of water
Eye examination Penlight
Snellen E chart
Newspaper
Opaque card
Ophthalmoscope
Ear examination Tuning fork
Otoscope
 EQUIPMENT USED DURING A PHYSICAL Assessment
Mouth, throat, nose, sinus examination Penlight
Gauze pad
Tongue depressor
Otoscope with wide teeth attachment
Thoracic and lung examination Stethoscope
Ruler and Skin marking pen
Heart and neck vessels Stethoscope
Two metric rulers
Peripheral vascular examination Sphygmomanometer and stethoscope
Tape measure
Tuning fork
Doppler ultrasound device
Abdominal examination Stethoscope
Tape measure and marker
Two small pillows
EQUIPMENT USED DURING A PHYSICAL Assessment
Musculoskeletal examination Tape measure
Goniometer
Male genitalia and rectal examination Gloves and lubricant
Penlight
Specimen card
Female genitalia and rectal examination Vaginal speculum
Bifid spatula, endocervical broom
Large swabs
Liquid pap medium
Specimen card
Neurologic examination Cotton tip applicator
Substances to smell and taste
Same equipment for eye exam
Object to feel
Percussion hammer
Tongue depressor
Tuning fork
Cotton ball and paper clip
 Preparing for Examination

Comfortable, Private Quiet Adequate Firm A bedside

warm room area area lighting examination table or
temperatur table or bed tray
e
 Preparing Oneself
● Assess your own feelings and anxieties before
examining the client
● Self-confidence in performing physical
assessment through practice the techniques
● The transmission of infectious agents should be
prevented during physical assessment
Preparing Oneself
Wash hand before the examination, immediately after direct contact with any
01 body fluids, blood, and contaminated items, and after the examination.

02
02 Always wear gloves.

When using pin or other sharp object, always

03 use a new one for the next patients.

Wear a mask and protective eye googles to avoid

04
being splashed with body fluids or blood.
 Approaching the client
01 Establish rapport with the client before
the examination

02 Respect the client’s desire and requests

03 Provide privacy to the client

04 Begin the examination with the less

intrusive procedures
Positioning the client

Sitting Position Standing Position

Positioning the client

Supine Position Prone Position

Positioning the client

Dorsal Recumbent Lithotomy Position

Position
Positioning the client

Knee-Chest
Sim’s Position Position
 Physical Assessment Technique
● Involves using the senses of vision, smell, and
hearing
● Used to observe and detect any normal and
abnormal findings
● Use the following guidelines as you practice the
technique of inspection:
1. Make sure the room is a comfortable temperature.
2. Use good lighting.
3. Look and observe before touching.
4. Only expose body parts being observed.
5. Note the following characteristics : color, patterns, size,
location, consistency, symmetry, movement, behavior,
odors, or sounds.
6. Compare the appearance of symmetric body parts Inspection
 Physical Assessment Technique
● Consists of using parts of the hand to
touch
● Palpation is used to feel the following
characteristics:
1. Texture
2. Temperature
3. Moisture
4. Mobility
5. Consistency
6. Strength of pulses
7. Size
8. Shape Palpation
9. Degree of tenderness
 Physical Assessment Technique
● Principles of Accurate Palpation:
1. Fingernails should be short.
2. Use sensitive part of the hand.
3. Light to deep palpation.
4. Palpate the tender area at the end of
the examination.
5. Let client take slow deep breaths to
promote muscle relaxation.
6. Assess skin turgor by lightly grasping
body part with fingertips.
Palpation
Physical Assessment Technique
Three parts of the hands are used during palpation:

Ulnar or
Fingerpads Dorsal Surface
Palmar Surface
Physical Assessment Technique
Three parts of the hands are used during palpation:

Ulnar or
Fingerpads Dorsal Surface
Palmar Surface
Fine
discrimination
Pulses Vibrations
Texture
Size Thrills Temperature
Consistency Fremitus
Shape
Crepitus
Physical Assessment Technique
Types of Palpation:
1. Light Palpation

✓ Place dominant hand lightly on the surface of the structure

✓ Little to no depression
✓ Use circular motion
Physical Assessment Technique
Types of Palpation:
2. Moderate Palpation

✓ Depress skin surface 1 to 2 cm (0.5 to 0.75 in)

✓ Feel palpable body organs and masses
Physical Assessment Technique
Types of Palpation:
3. Deep Palpation

✓ Place dominant hand on skin surface and nondominant

hand on top of dominant hand to apply pressure
✓ Depress skin surface between 2.5 and 5 cm (1 and 2 in)
Physical Assessment Technique
Types of Palpation:
4. Bimanual Palpation

✓ Use two hands, place one on each side of the body part being palpated
✓ Use one hand to apply pressure and the other hand to feel the
structure
✓ Note the size, shape, consistency, mobility of the structures
 Physical Assessment Technique
● Involves tapping body parts to
produce sound waves
● Uses of percussion:
1. Eliciting pain
2. Determining location, size, and
shape
3. Determining density
4. Detecting abnormal masses
5. Eliciting reflexes
Percussion
Physical Assessment Technique
Types of Percussion:
1. Direct Percussion

✓ Direct tapping of body part with one or two fingertips to

elicit possible tenderness
Physical Assessment Technique
Types of Percussion:
2. Blunt Percussion

✓ Used to detect tenderness over organs by placing one hand flat

on the body surface and using the fist of the other hand to strike
the back of the hand
Physical Assessment Technique
Types of Percussion:
3. Indirect Percussion

✓ Most commonly used method of percussion

✓ Produces sound or tone that varies with the density of
underlying structures
Physical Assessment Technique
Types of Percussion:
3. Indirect Percussion
The following techniques help to develop proficiency in the technique of
indirect percussion:
1. Place the middle finger of your nondominant hand on the body part you are
going to percuss.
2. Keep your other fingers off the body part being percussed because they will
damp the tone you elicit.
3. Use the pad of your middle finger of the other hand (ensure that this
fingernail is short) to strike the middle finger of your nondominant hand that
is placed on the body part.
4. Withdraw your finger immediately to avoid damping the tone.
5. Deliver two quick taps and listen carefully to the tone.
6. Use quick, sharp taps by quickly flexing your wrist, not your forearm.
 Physical Assessment Technique
Solid tissue produces a soft tone, fluid produces a louder tone, air
produces an even louder tone.
Sound Intensity Pitch Length Quality Example of Origin
Resonance Loud Low Long Hollow Normal lung
Hyper-resonance Very loud Low Long Booming Lung with
emphysema
Tympany Loud High Moderate Drum-like Puffed-out cheek
Gastric bubble
Dullness Medium Medium Moderate Thud-like Diaphragm
Pleural effusion
Liver
Flatness Soft High Short Flat Muscle
Bone
Sternum
Thigh
 Physical Assessment Technique
● Direct or Immediate
Auscultation
- Accomplished by unassisted
ear without amplifying device.
- Involves application of ear
directly to a body surface.
● Mediate Auscultation
- Use of stethoscope in the
detection of body sounds. Auscultation
 Physical Assessment Technique

• Use to listen to:

1. Heart sounds
2. Movement of blood
through cardiovascular
system
3. Movement of bowel
4. Movement of air through
the respiratory tract Auscultation
 Physical Assessment Technique
● These guidelines should be followed
as you practice the technique of
auscultation:
1. Eliminate distracting or competing
noises from the environment (e.g.,
radio, television, machinery).
2. Expose the body part you are going
to auscultate.
3. Do not auscultate through the client’s
clothing or gown. Rubbing against the
clothing obscures the body sounds. Auscultation
Physical Assessment Technique

Stethoscope
Physical Assessment Technique
When to use the Diaphragm and the Bell?
Diaphragm Bell

➢ Best for higher pitch ➢ Best for lower pitch

sounds sounds
➢ For the breath sounds ➢ For some bowel sounds,
and normal heart sounds heart murmurs, bruits

Stethoscope
 Physical Assessment Technique

• Another skill that used during

assessment, certain alteration is
body function create
characteristic body odors,
smelling can detect
abnormalities that unrecognized
by other means.
Olfaction
 Physical Assessment Technique

• Assessment of characteristic
odors:
• Alcohol odor from oral cavity
means ingestion of alcohol.
• Ammonia from urine means
urinary tract infection.
• Body odor from skin, particularly
in areas where body parts rub
together means poor hygiene,
excess perspiration (bromidrosis). Olfaction
 Physical Assessment Technique

• Assessment of characteristic odors:

• Feces odor from wound site means wound
abscess.
• Foul–smelling stools in infant from stool
means mal absorption syndrome.
• Halitosis from oral cavity means poor
dental and oral hygiene, gum disease.
• Sweet, fruity ketones from oral cavity may
be from diabetic acidosis.

• Musty odor from casted body part means

infection inside cast. Olfaction
 Client’s Chart
• Any relevant record made by a health care practitioner at the time
of, or subsequent to, a consultation and/or examination or the
application of health management.
• A thorough record of a patient’s medical history and clinical data.
• Medical charts contain medically relevant events that have
happened to a person.
• A good medical chart will paint a clear picture of the patient.
• Complete medical charts help ensure patients receive the best care
possible.
• Medical charts provide healthcare providers a glimpse into a
patient’s medical history and provide vital details to help clinicians
make sound care decisions.
 Client’s Chart
• Information include:

1. Demographics
2. Developmental History
3. Immunization Records
4. Medications
5. Medical allergies
6. Surgical history
7. Obstetric history
8. Family History
9. Social History
10. Habits
 Client’s Chart
• A chart can include:
1. Hand-written contemporaneous notes taken by the health care
practitioner.
2. Notes taken by previous practitioners attending health care or other
health care practitioners
3. Referral letters to and from other health care practitioners.
4. Laboratory reports and other laboratory evidence
5. Audio visual records such as photographs, videos and tape-recordings.
6. Clinical research forms and clinical trial data.
7. Other forms completed during the health interaction such as insurance
forms, disability assessments and documentation of injury on duty.
8. Death certificates and autopsy reports.
 Client’s Chart
• Who can access the client’s chart?
- Individual medical charts must be treated with extreme
care.
- Only the patient and the healthcare team members
involved in their care are allowed to view or add to a
medical chart.
- Medical charts belong to the patient.
- He or she has the right to make sure the chart is accurate
and can grant another party access to the chart.
Validation of data
Purpose of Validation
● Validation is the process of confirming or
verifying that the subjective and objective data
collected are reliable and accurate.
● Steps of Validation:
1. Deciding if the data needs validation
2. Determine ways to validate data
3. Identifying areas where data is missing
Data Requiring Validation
● Conditions that require data to be rechecked
and validated:
1. Discrepancies or gap between subjective and
objective data
2. Discrepancies or gaps between what the client
says at one time versus another time
3. Finding highly abnormal or inconsistent with
other findings
 Methods of Validation
● Recheck own data through a repeat
assessment
● Clarify data with the client by asking additional
questions
● Verify the data with another health care
professional
● Compare objective findings with subjective
findings
References:
● Weber, J. R., & Kelley, J. H. (2013). Health assessment
in nursing. Lippincott Williams & Wilkins.

WEBSITES:
● https://www.carecloud.com/continuum/what-is-a-
medical-chart/
● https://www.medicalprotection.org/southafrica/jun
ior-doctor/volume-7-issue-1/the-importance-of-
keeping-good-medical-records