University of Southern Mindanao

College of Health Sciences

Health Assessment Basic Skills
 Physical Examination
Purposes:
• Routine screening.
• Eligibility for employment, school
activities, physical activities, medical
insurance, military service.
• Hospital Admission.
• Establishing a data base for the
patient.
• Identifying patient problems requiring
intervention.
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• Evaluating the effectiveness of care.
• Developing credibility for promoting
nurse- patient relationship.
a) Nurse in all health care settings
typically perform complete physical
examinations.
b) In all settings the physical
examination should be integrated into
the nurses’ routine care.
c) The nurse must first learn to identify
normal characteristics before
attempting to distinguish abnormal
findings.
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Draping during the Physical
Assessment

Purposes:
• To prevent unnecessary
exposure.
• To provide privacy.
• To keep the client warm.

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Considerations:
1) The method of draping varies
with the position of the patient,
examination being done and the
room temperature.
2) As the examination is conducted,
only those body parts being
assessed are exposed.
3) Draping should be loose enough
to allow quick change of position
but anchored securely t prevent
unnecessary exposure
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 Techniques necessary for an
accurate physical examination
1. Observation, measurement and
history taking.
2. INSPECTION- visual and olfactory
inspection to observe color, odor,
size, shape symmetry and movement.
3. PALPATION- using the sense of touch
simultaneously with inspection to
identify softness, rigidity,
temperature and to determine
position, size, texture, consistency
and moisture.
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• PERCUSSION- striking body surfaces,
producing sounds to determine if
underlying tissues are air-filled, fluid
filled, or solid.
Percussion sounds include:
 Flat : non-resonant; soft tissues
 Dull : thudlike; solid organs
 Resonant : hollow
 Hyperresonant : booming
 Tympanic : over gas- filled
organs; drumlike
• AUSCULTATION- listening to sounds
(usually with stethoscope) produced as
to their frequency, intensity, quality
and duration. Low pitched sounds.
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Norz, Dindo, Weng & Ems
Preparation for Examination
The environment must be suitable
and all equipments must be
completed before the
examination begins.
1. Preparation of the environment
a)The examination is
performed in privacy.
b)Adequate lighting is
required for proper
illumination of body parts,
observation, and inspection.
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c.) The examination room
should be soundproof if
possible; if not, all extraneous
noise should be eliminated.
d.) The examination table
should be comfortable for the
patient.

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2. Preparation of the equipment.

a) Equipment and hands should

be clean and be kept warm.
b) All equipment should function
properly.
c) All equipment should be
gathered prior to the beginning
of the examination and should
be kept within easy reach of the
examiner.

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3. Physical preparation of the
patient.
a) The patient should be asked to void
prior to the examination.
b) The reason for the specimen collection
should be explained to the patient.
c) The patient should be properly
positioned and draped for examination.
d) The patient should be kept warm and
out of drafts; seriously ill patients are
more susceptible to chills.
e) The patient should be provided with
privacy and adequate time to dress and
undress.

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4. Psychological preparation of the
patient.
a) Provide reassurance and support to
decrease patient anxiety and
embarrassment.
b) Explain actions clearly and in details
using simple explanations.
c) Acquire a third person to be in the
examination room when the patient
and examiner are of the opposite
sex.
d) Monitor the patient’s emotional
responses throughout the
examination.
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 Positioning for Physical
Examination
Considerations:
1. It is important to consider the client’s
energy level and privacy.
2. Clients who are weak may require
assistance with positioning.
3. Uncomfortable or embarrassing
positions should not be maintained
for long periods.
4. The examination should be organized
so that several body systems can be
assessed with the client in one
position.
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 SITTING POSITION
Purposes:
1. Sitting upright
provides good
visualization of
the symmetry of
the upper body.
2. Allows full lung
expansion.
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Areas used to assess include:
1.Head and neck
2.Anterior and posterior thorax
and lungs
3.Breast
4. Axilla
5.Heart
6.Upper extremities
7.To take vital signs

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Considerations:
1.The client may sit upright in a
chair, on the side of an
examining table or bed.
2.Physically weak patients may
not be able to sit. A supine
position with the head of the
bed elevated can be used
instead.

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Procedure:
1.Position the buttocks against the
back of the chair. Hips and knees
are flexed at the right angle to the
trunk.
2.Keep the trunk and head as in
standing position.
3.Place feet flat on the floor at 90°
angle to the lower legs.
4.If the chair has arms, flex the
elbows and place the forearms on
the armrest to avoid shoulder
strain.
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 SUPINE POSITION

The supine position is normally the

most relaxed position.
Purposes:
1)Prevents contracture of the
abdominal muscles.
2)Provide easy access to pulse
points.
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Areas used to assess includes:
1.Head and neck
2.Anterior thorax and lungs
3.Breast
4.Axilla
5.Heart
6.Abdomen
7.Extremities
8.Peripheral pulses

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Considerations:
1) This position allows relaxation
of abdominal muscles.
2) The supine position may be
difficult for patients
experiencing shortness of
breath.
Procedures:
1) The patient lies flat on the back
with legs together but
extended and slightly flexed at
the knees.
2) The head may be supported
with a small pillow.
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DORSAL RECUMBENT
POSITION

Purposes:
1)Vaginal examination
2)Digital examination of rectum
3)Pelvic examination
4)Catheterization

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Areas used to assess includes:
1.Head and neck
2.Anterior thorax and lungs
3.Breast and axilla
4.Heart
5.Extremities
6.Peripheral pulses

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Considerations:
1)Bending the knees in the dorsal
recumbent position may be more
comfortable for patients with
painful disorders
2)This position cannot be used to
assess the abdomen since it
promotes contracture of the
abdominal muscles.
Procedures:
1)The patient lies on the back with
legs separated, knees bent, and
soles of the feet flat on bed.
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2.) On the Internal Examination table:
a)Bring buttocks of the client to
extreme edge of the examining table
and place the feet on extension.
b)Drape is placed diagonally over the
patient with opposite corners in
place between the legs.
c)Place Kelly or disposable pad under
patient’s buttocks
d)The corner of the drape between
the patient’s legs is raised on folded
back on the abdomen to expose the
part being examined.
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 SIMS POSITION

Purpose:
1)Used to assess the rectum or
the vagina
Consideration:
1)Joint deformities may prevent
the patient from assuming this
position.
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Procedure:
1)Place top sheet.
2)The client lies on either the
right or the left side.
3)The lower arm is behind the
body and the upper arm is
flexed at the shoulder and
elbow.
4)The knees are both flexed, with
the uppermost leg more
accurately flexed.
Norz, Dindo, Weng & Ems
 PRONE POSITION

Purposes:
1)It is used to assess the hip joint.
2)Can be used to assess the
posterior thorax.
Consideration:
1)This position is difficult to assume
for many clients.
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Procedure:
1)Place top sheet.
2)The client lies on the abdomen,
flat on bed, with the head turned
to one side.

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 LITHOTOMY POSITION

Purposes:
1)Examination of the rectum and
female genitalia
2)Delivery of the newborn
3)Cystoscopic examination.
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Considerations:
1)It is uncomfortable for the older
clients.
2)It is often embarrassing, so time spent
in this position should be minimized.
3)Lithotomy position provides the
greatest exposure of genitalia and
allows insertion of vaginal speculum.
Procedures:
1)Place top sheet.
2)The client is in dorsal recumbent
position with the buttocks at the edge
of the examining table and the feet
supported in stirrups.
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KNEE-CHEST OR GENU-
PECTORAL POSITION

Purpose:
1)The position is used for the
examination of rectal area.
Consideration:The same
precautions should be used as
with the lithotomy position.
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 Instruments, equipments and
supplies needed for Physical
Examination
Instruments:
1)Blood pressure

2)Stethoscope

3)Ophthalmoscope

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4.) Otoscope

5.) Snellen’s chart

6.)Nasal speculum

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7.) Weighing scale

8.) Vaginal speculum

9.)Tuning fork

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10.) Percussion hammer

11.)Neurologic hammer

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Equipments and Supplies:
1. Alcohol swabs (testing sense of
2. Cotton applicators smell)
3. Disposable pad 12. Tape measure
4. Cotton balls with 13. Thermometer
antiseptic solution 14. Tongue depressor
5. Gauze dressing 15. Kidney basin
(4x4) 16. Tissue paper
6. Drape 17. Lab slides or test
7. Gloves (sterile and tubes
non-sterile/ clean) 18. Clean white towel
8. Lubricant
9. Penlight
10. Safety pins
11. Cologne or perfume
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Norz, Dindo, Weng & Ems