PHYSICAL ASSESSMENT

AND EXAMINATION

MR SANDWE T.K
MR SANDWE T.K
 WHY PHYSICAL ASSESSMENT?
• It provides a framework
• It individualises nursing care
• Amount and quality of information
maximised
• Provides a decision-making basis
• It provides baseline data
• It promotes the early development of a
relationship with the patient
(Suna et al 1982)
MR SANDWE T.K
Cont’
• It comprises of
• 1. clinical interview to obtain subjective data
• 2. physical examination to obtain objective data

MR SANDWE T.K
Physical examination
• Basic Materials
• Such as drapes, gown, thermometer, BP machine,
ophthalmoscope, penlight, Stethoscope

• Materials for gathering specimens

• Such as specimen cup, culture media, glass slides etc

MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
• Inspection
Inspection is the most important of the
four basic techniques, although it is often
accepted as a matter of course and is not
fully utilised. Inspection is a continuous
process and actually begins during history
taking and continues throughout, even
while other techniques are being used.
Inspection can be defined as observation
with a purpose. The senses involved in
this technique are vision, hearing and
smell.
MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
• Inspection
Inspection is from general to specific, a general
picture is observed during general survey and a
specific inspection of parts of the body is done.
General to specific must therefore be made of each
part of the body. The first thing to note is the general
appearance of a body part and then individual
particulars of a body like size, shape, location, colour,
texture and movement of structures is observed. The
area being examined is then composed with opposite
side of the body so that a symmetrical bilateral
pattern is followed.

MR SANDWE T.K
PHYSICAL EXAMINATION TECHNIQUES
Palpation
During palpation, the body is examined using the
sense of touch to determine the characteristics of
tissues and organs. The presence, absence and/or
nature of masses, swelling, spasm, tenderness and
pain, stiffness, enlargement, elasticity,
crepitations, texture and fluid can be determined.
Not only are parts of the body palpated, but also
temperature is determined and sensations of
movement, position, shape and consistency are
experienced.

MR SANDWE T.K
PHYSICAL EXAMINATION TECHNIQUES
Palpation
Palpation is sophisticated technique
that is masters by repeated practice.
This also holds true for the
interpretation of findings. This
technique is often used in conjunction
with inspection.

MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
Palpation Techniques
The examiner’s hands should be warm and the client
must be relaxed. Muscle tension can hamper the
results of palpation. When a client’s abdomen is being
palpated, he/she can be requested to bend their knees
to relax the muscles. If tender areas are discovered,
they must be palpated last. The symmetrical pattern
must be followed during palpation. The examiner
must also bear in mind that the different parts of the
hands differ in sensitivity. Various parts of the hand
are therefore utilised for palpating different parts of
the body.
.
MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
Palpation Techniques
a. Light Palpation
Slight pressure is placed on the client’s
skin using the fingertips (cushions) to a
depth of 1-2 centimetres from the body
surface. This technique is used primarily
to ascertain slight tenderness and muscle
tone. The hand is parallel to the part
being palpated, the fingers are stretched
out, kept together and moderate pressure
is exerted on the body part.
MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
Palpation Techniques
b. Deep Palpation
Greater pressure is exerted on the body surface to a
depth of 3-4 centimetres. One or both hands are used
than that in light palpation. To perform deep
palpation on the abdomen, the fingers are stretched
out with the fingertips slightly angled, pressure is
exerted on the skin. This cause the underlying organs
to move to and fro under the fingertips and
abdominal masses and organs cab be localised in this
way. Rebound tenderness can be checked using deep
palpation but should not be done in a client with
severe pain.
MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
Palpation Techniques
b. Deep Palpation
The relevant area is palpated deeply and
slowly and the pressure is suddenly
reduced by removing the hand quickly.
The sudden reduction in pressure will
cause pain. To confirm the actual
presence of rebound tenderness, the same
technique can be tested on surrounding
tissue and the patient’s reaction
evaluated.
MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
Palpation Techniques
c. Ballottement
Ballottement is used to determine freely mobile
masses beneath the abdominal wall. Quick pressure
causes solid tissue to move. The examiner must begin
from low down on the abdomen and works upwards
with a quick, light bouncing movement of the
fingertips. When ascites is suspected, deep
ballottement can be used by placing the fingertips at
right angles to the abdominal wall.

MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
Palpation Techniques
c. Ballottement
Deep and rapid palpation is done by
keeping the fingers together. When the
pressure is decreased, the fingers must
remain in contact with the abdominal
wall. The movement of mobile organs can
be palpated in this way.

MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
• Percussion
The body surface is tapped lightly but with a
sharp rapid movement. Sounds are produced
which give an indication of the density, size,
position and shape of the underlying organs.
The quality of the sounds that are obtained
varies depending on the density of the
underlying tissue and this is particular value
in determining the relative quantity of air or
solid matter in the lung, or in determining
where the borders of the organs are.
MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
• Percussion
During percussion the body surface
vibrates and the sound is transmitted to
the underlying tissue. The sound is then
reflected in accordance with the
composition of the underlying tissue. The
density of air or solid tissue to a depth of
5-7 centimetres in a body cavity or organ
is determined in this way. The vibrations
caused by percussion only involve the
tissue contiguous to the finger that is
percussing.
MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
• Percussion
Percussion on bones is influenced by lateral
transmission of the vibrations and therefore is
unreliable. The percussion hammer (patella-reflex) is
used during a neurological examination to tap the
tendons. The tendon is stretched and in this way a
deep tendon reflex is elicited. . Sounds are classified
according to their intensity, pitch, duration and
quality. The nature of the sounds presenting in
specific systems are best discussed when the
examination of the systems are described.

MR SANDWE T.K
PHYSICAL EXAMINATION TECHNIQUES
Percussion
a. Direct Percussion
Percussing directly on the body surface
with the fingers or with one finger,
usually the middle finger, used to
percuss a baby’s thorax or an adult’s
sinuses

MR SANDWE T.K
PHYSICAL EXAMINATION TECHNIQUES
Percussion
b. Indirect Percussion
Utilised for examining the thorasic
and abdomen. The finger doing the
percussing is called the plexor and the
finger being percussed the pleximeter.
The pleximeter (middle finger) is
placed on the body surface, without the
palm of the hand and other fingers
touching the body.

MR SANDWE T.K
 PHYSICAL EXAMINATION TECHNIQUES
Percussion
b. Indirect Percussion
The tip of the plexor (middle finger of the other
hand) is now used to percuss on, or distal to, the
distal interphalangeal joint of the pleximeter.
Percussion must be rapid and sharp with the plexor
at right angles to pleximeter. The strength and
rapidity of the percussion is made possible by wrist
action. The plexor must be removed from the
pleximeter so that the sounds are not absorbed by it.
The fingernail of the plexor should be short to
prevent injury to the pleximeter.

MR SANDWE T.K
PHYSICAL EXAMINATION TECHNIQUES
Percussion
c. Fist Percussion
One hand is placed flat on the body
surface and then struck with the lateral
aspect of a clenched fist. Primarily used
on the lower aspect of the back to
determine the presence of pain or
tenderness due to renal, liver or gall
bladder problems.

MR SANDWE T.K
PHYSICAL EXAMINATION TECHNIQUES
• Auscultation
Auscultation embraces listening to sounds
that are present in the body, primarily to
listen to sounds produced by thorasic and
abdominal organs or the movement of
blood in the cardiovascular system. Sounds
are classified according to their intensity,
pitch, duration and quality. The nature of
the sounds presenting in specific systems
are best discussed when the examination of
the systems are described.

MR SANDWE T.K
PHYSICAL EXAMINATION TECHNIQUES
• Auscultation
a. Direct Auscultation
This is done by use of the ear without any
equipment. The ear is placed directly
onto the body surface where the sound
is most prominent
b. Indirect Auscultation
This is done by means of a stethoscope
and the sounds of the surface are
blocked out
MR SANDWE T.K
PHYSICAL EXAMINATION
SEQUENCE

•1. The General Survey

• a. Appearance and Mental
Status
• b. Patient Instructions
• c. Measurements
d. Vital Signs

MR SANDWE T.K
 PHYSICAL EXAMINATION SEQUENCE
1. The General Survey
a. Appearance and Mental Status
- Compare the client’s stated age with the
client’s appearance
- Observe the client’s body build, height and
weight in relation to the client’s age,
lifestyle and health
- Observe the client’s facial expression,
posture and position
-
MR SANDWE T.K
PHYSICAL EXAMINATION SEQUENCE
1. The General Survey
a. Appearance and Mental Status
- Observe the client’s overall hygiene and
grooming, relating these to the client’s
activities just before assessment
- Note the client’s body odor and breath
odor, again relating these to the client’s
prior activities
-
MR SANDWE T.K
PHYSICAL EXAMINATION SEQUENCE
1. The General Survey
a. Appearance and Mental Status
- Note signs of health or illness e.g.
-Skin colour, breathing, bending over because of
abdominal pain,
- Facial expression such as wincing
- Mobility
Use of assistive devices, Gait, Sitting,rising from
chair, Taking off coat
- Dress and posture

MR SANDWE T.K
PHYSICAL EXAMINATION SEQUENCE
1. The General Survey
a. Appearance and Mental Status
- - Dress and posture
- Speech pattern, disorders, foreign language
- Difficulty hearing, assistive devices
- Stature and build
-- Assess the client’s attitude, attentiveness, affect and
mood and assess the appropriateness of the client’s
responses
-- Listen for the quantity of speech, quality, relevance and
organisation

MR SANDWE T.K
PHYSICAL EXAMINATION
SEQUENCE
• 1. The General Survey
b. Patient Instructions
Respecting modesty, instruct the
client to empty the bladder, remove
as much clothing as is necessary and
put on a gown. Then begin the
examination. A suggested sequence
follows.

MR SANDWE T.K
PHYSICAL EXAMINATION
SEQUENCE
1. The General Survey
c. Measurements
- Measure the client’s height
- Measure the client’s weight
- Measure the client’s skin fold
thickness, if appropriate
- Assess distance vision:
Snellen chart
MR SANDWE T.K
PHYSICAL EXAMINATION
SEQUENCE
1. The General Survey
d. Vital Signs
- Assess the client’s radial pulse
- Count the client’s respirations
- Take the client’s temperature
- Measure the client’s blood pressure
- Document vital signs in both arms

MR SANDWE T.K
PHYSICAL EXAMINATION
SEQUENCE
• 2. Skin, Hair and Nails
• 3. Head and Face
• 4. Eyes and Vision
• 5. Ears and Hearing
• 6. Nose and Sinuses

•
MR SANDWE T.K
PHYSICAL EXAMINATION
SEQUENCE

• 7. Mouth and Throat

• 8. Neck
• 9. Upper Extremities
• 10. Back and Posterior Chest
• 11. Lungs

MR SANDWE T.K
PHYSICAL EXAMINATION
SEQUENCE

•12. Anterior Chest

•13. Heart
• 14. Breasts and Axillae
•15. Abdomen
• 16. Inguinal Region
MR SANDWE T.K
PHYSICAL EXAMINATION
SEQUENCE

•17. Lower Extremities

•18. Musculoskeletal
•19. Neurologic
•20. Male Genitals and
Rectum
•21. Female Genitals and
Rectum
MR SANDWE T.K
PHYSICAL EXAMINATION
CONCLUSION
• Answer any questions the client might
have and provide health teaching as
appropriate
• Before leaving the room, make sure the
client is not experiencing any discomfort
from the examination.
• Record your assessment data as soon as
possible, preferably immediately after
the examination.
MR SANDWE T.K
DOCUMENTATION

•Content
• Timing.
•Format
•Accountability
•Confidentiality.

MR SANDWE T.K