Physical Examination

• It is the process of examining the patient’s body to determine the

presence or absence of physical problems.

• A systemic approach of using senses applying different techniques

to gather objective data to identify and manage health problem

• The goal of the physical examination is to obtain valid information

concerning the health of the patient.
• The examiner must be able to identify, analyze, and synthesize the
accumulated information into a comprehensive assessment.
 Principles of Conducting Physical Examination
• Wash your hands, using 7steps to reduce the transmission of disease.
• Head to toe approach
• The patient should be made as comfortable as possible during the
examination.
• The patient should be properly draped.
• The examining table/bed be situated so that the examiner has access
to both sides of the patient.
• An ideal arrangement is to have the table located in the center of the
examining room.
• Stand on the right side.
• Follow a sequence
• Expose only those area that are being examined at that time
without undue exposure of the other areas.
• This caring for the patient’s privacy goes a long way in
establishing a good doctor-patient relationship.
• The examiner should continue speaking to the patient.
• Showing care to his disease and answer to patient’s
questions.
• It can not only release patient’s nervousness, but also help
to establish the good physician-patient relationship
 Precautions
• The use of gloves should provide adequate protection when
performing the physical examination or when handling blood-soiled
or body fluid-soiled sheets or clothing.
• Gloves should be worn when examining any individual with exudative
lesions or dermatitis.
• Hands or other contaminated skin surfaces should be washed
thoroughly and immediately if accidentally soiled with blood or other
body fluids.
• All sharp items, such as needle, must be handled with extraordinary
care to prevent injuries.
• A patient may be in isolation or on special precautions if he/she is
suffering from a contagious disease.

Preparing for assessment

• Explain when, where and why the assessment will take place.

• Help the client prepare (empty bladder, change clothes).

• Prepare the environment (lighting, temperature, equipment, drapes,
privacy)

• Equipment should be within reach, arranged as per need and Clean &
warm.
Equipment's for physical examination
 Positioning
Positions used during nursing assessment, medical
examinations, and during diagnostic procedures:
• Dorsal recumbent
• Supine
• Sims
• Prone
• Lithotomy
• Sitting
 Techniques of Physical Examination
The four cardinal techniques of physical examination are:

• Inspection
• Palpation
• Percussion
• Auscultation
 Inspection
It is also known as concentrated watching •
Take time to “observe” with eyes, ears, nose.
• Use good lighting.
• Look at color, shape, symmetry, position.
• Odors from skin, breath, wound.
• Inspection is done alone and in combination with other
assessment techniques
 • Inspection begins the moment you first meet the
individual and develop a “general survey”
Palpation
• It is the act of touching a patient in a therapeutic manner to elicit
specific information.
• Touch with different parts of hands: Dorsum / finger / ball of
hands
• With different degree of pressure:
• Light: 1-2 cm (½ - 1 inch )
• Deep: 4-5 cm (1 to 2 inches or more)
• Bimanual: using both hands to trap organ (e.g., uterus, breasts,
spleen)
 Percussion
• A methods of “tapping” of body parts during physical examination
with fingers, hands, or small instruments to evaluate the size,
consistency, borders and presence of fluid in body organs.
• Percussion of a body part produces a sound that indicates the type of
tissue within the organ.
• It is particularly important in examining the chest and abdomen.
• Produces different notes depending on underlying mass (dull,
resonant, flat, tympani).

Types of percussion
• Indirect Percussion.

• Direct Percussion.

• Blunt percussion.
 Percussion Sounds
RECORD OF FINDING QUALITY WHERE HEARD

Resonance Hollow Normal lung

Hyper resonance Booming Air-filled lungs
Tympany Drum like Abdomen
Dullness Thud like Liver
Flatness Flat Muscle, bone
 Auscultation
• It is the act of active listening to the body organs to gather information on
patient’s clinical status.
• Auscultation includes listening to sounds that are voluntarily and
involuntarily produced by the body such as the heart and blood vessels
and the lungs and abdomen.
• Direct auscultation – sounds are audible without stethoscope
• Indirect auscultation – uses stethoscope
• Fine-tune your ears to pick up subtle changes (practice)
• Flat diaphragm picks up high-pitched respiratory sounds best
• Bell picks up low pitched sounds such as heart murmurs, bruits, aortic
aneurysm
 Components of Physical Examination:

• General survey (the nurses’ initial observation for the clients’

general appearance and behavior).

• Vital signs measurement

• Height and weight measurement

• Body systems examination

 General Survey
• Begins with the first moment of the encounter with the patient and
continues throughout the health history
• First component of the assessment
• Contributes to formation of global impression of the person
• Includes physical appearance, body structure, mobility, and behavior
Physical Appearance
Normal Range of Findings Abnormal Findings
1- Age – the person appears his or her stated Appears older, smaller, or younger, as with
age. chronic disease or retardation.
 2- Sex – Sexual development is appropriate
for gender and age
3- Level of consciousness – the person is
alert and oriented, attends to your questions
and responds appropriately.
Alert. Follow commands and responds
completely and appropriately to stimuli
Physical Appearance
Normal Range of Findings
4- Skin color – color tone is even, skin
is intact with no obvious lesions
Delayed or early puberty, or inappropriate to
gender.
Lethargic. The patient is sleepy or drowsy
and will awaken and respond appropriately to
command .
Stupor. require vigorous stimulation for a
response .
Semi coma. The patient is not awake but will
respond purposefully to deep pain
Coma. The patient is completely unresponsive.
Abnormal Findings
• Pallor, (loss of color)
• cyanosis, (bluish discoloration) •

5- Facial features – symmetric with
movement.
6- No signs of acute distress are
present
jaundice Yellowish discoloration)
• lesions.
• Immobile, masklike, asymmetric,
drooping.
• shortness of breath, wheezing.
• facial grimace, holding body part.
(Pain)

Body Structure
1- Stature – the height appears within • Excessively short or tall
normal range for age.
2- Nutritional status – the weight • Underweight
appears within normal range for height • Obese
and body build.
3- Symmetry – body parts look equal • Unilateral atrophy
bilaterally • hypertrophy
(enlargement of muscles.)
4- Posture – the person stands • Rigid spine and neck (moves as one
comfortably erect as appropriate for unit) e.g., arthritis. Stiff and tense.
age.

Body Structure
5- Position – the person sits
comfortably in a chair or on the bed or
examination table, arms relaxed at
sides, head turned to examiner.
• Leaning forward with arms braced on
chair arms (chronic pulmonary
disease).
• Sitting straight up and resists lying
down, (left-sided congestive heart
failure).

6- Physical deformities– Absence of

Presence of deformities or congenital
any congenital or acquired defects.
defect

Mobility
1-Gait: the walk is smooth, even, and Limping with injury.
well-balanced; and associated Difficulty stopping
movements, (symmetric arm swing),
are present.

2-Range of motion – the person has full Limited joint range of motion. Paralysis –
mobility for each joint. absent movement.

Movement jerky,
3- Involuntary movement: absent
uncoordinated
Tics, tremors, seizures

Behavior
1- Facial expression – the person Flat, depressed, angry, sad anxious.
maintains eye contact expressions are However, note that anxiety is common in
appropriate to the situation. ill people.

2- Mood and affect – the person is Hostile, distrustful, suspicious, crying

comfortable and cooperative with the
examiner and interacts pleasantly.

Vital signs are the key physiologic measures of the person’s general health state.
The nurse obtains vital signs to:
• Establish baseline measurement.
• Identify physiologic problems.
• Monitor clients’ response to therapy.
 Signs range
• Pulse rate 60 - 100 beats/min
• Respiratory rate 12 - 20 breath/min
• Blood pressure 100/70 to 140/90 mmHg
• Temperature 36.5 - 37.5 C
• Pain

Measuring Height and weight

Body mass index _Weight_(kg)____

(Height) 2
Where
 Weight is measured in kilograms.
Height is measured in meters
Body mass index findings
< 20 Person is under weight
=20-25 Person is normal weight
=25-30 Person is overweight
>30 Person is obese

Body systems examination

• Body systems examination is the systematic objective evaluation of client’s
body structures, parts, and organs, using the examiners’ sense
 Integumentary system
Integument includes skin, hair, and nails(inspect and palpate)

Skin: Rashes, lesions, changes, dryness, itching, color change.

Hair: Color, Texture, Distribution
Nails Shape and color of Nails
 HEENT
Head: Inspection and palpation
• Size, shape, symmetry

Eyes: Inspection and palpation

• Inspect and palpate lids, lashes, inspect eye position and symmetry , size of pupils
• Visual acuity with Snellen chart

Ears: Inspection and palpation

• Inspect size, shape, position, discharge, lesions.
 HEENT
• Palpate for tenderness, any lesions
• Nose and sinuses: Inspection, palpation and percussion

• Inspect color of mucosa, presence of discharge.

• Palpate for tenderness.

• Percuss for tenderness over frontal and maxillary sinuses

• Mouth: Inspection and palpation
 HEENT
• Inspect and palpate lips, tongue, oral cavity, tonsils, pharynx (color,
moisture), teeth, breath, presence of exudates, erythema, lesions, palate. •
Throat and neck: Inspect And Palpate neck for trachea (should be at
midline), thyroid, lymph nodes.

• Auscultate carotids for bruits (bell)

• If bruit is heard, palpate for carotid thrill
• Palpate one side at a time
 HEENT
• Perform ROM on neck
 THORAX AND LUNGS

Thorax : Assess size and shape of thorax.

• Look for deformities . Barrel chest from asthma or COPD. Lungs: Inspect,
Palpate, Percuss (normal note is resonance), Auscultate
• Assess and document respiratory rate, rhythm, and effort.

Breath sounds: Auscultate Using Diaphragm.

Normal Breath Sounds:
• Broncho vesicular.
• Bronchial.
 • Vesicular.
• Tracheal.
Adventitious Sounds: Abnormal Breath Sounds
Breasts and axilla

In a woman, inspect the breasts with her arms relaxed, then elevated,
and then with her hands pressed on her hips. inspect the axillae and
feel for the axillary nodes.
Inspect for symmetry, contour (shape), look for any areas of hyper
pigmentation, retraction or dimpling, edema.

Palpate breasts, areola, nipples and axillary lymph nodes in both men
and women.
Cardiovascular system

• Observe the jugular venous pulsations, and measure the jugular venous
pressure.
• Inspect and palpate the carotid pulsations.
• Listen for carotid bruits.
• Inspect and palpate the precordium.
• Note the location, diameter, amplitude, and duration of the apical impulse.
• listen for the first and second heart sounds.
• Listen for any abnormal heart sounds or murmurs.
 Abdomen

• Inspect, auscultate, and percuss the abdomen. Palpate lightly, then

deeply. Assess the liver and spleen by percussion and then palpation.

• Try to feel the kidneys, and palpate the aorta and its pulsations.

Musculoskeletal System
• Note any deformities or enlarged joints.
• Palpate the joints, check their range of motion, and perform any necessary
maneuvers.
Nervous system:
• Assess lower extremity muscle bulk, tone, and strength; also sensation and
reflexes. Observe any abnormal movements.
Asses:
• Mental status
• Cranial nerve
• Motor nerve
• Sensory nerve
Thank you