The physical examination is a process during which you use your senses to collect objective data. You will need all of the skills of assessment— cognitive, psychomotor, interpersonal, affecti ve, and ethical/legal—to perform an accurate, thorough physical assessment. You also need to know normal findings before you can begin to distinguish abnormal ones.
Health history allows you to see your patient subjectively through hers or his eyes, the physical examination now allows you to see your patient objectively through your senses. objectively through your senses. The objective data complete the patient’s health picture.
The goal of physical assessment is not only to identify actual or potential health problems but also to discover your patient’s strengths. For example, you can use the physical examination to assess clues you obtained from the history. Combined with the history data, your physical assessment findings are essential in formulating nursing diagnoses and developing a plan of care for your patient.
A complete physical assessment includes a general survey; vital sign measurements;assessment of height and weight; and physicalexamination of all structures, organs, and bodysystems. Perform it when you are examining apatient for the first time andneed to establish a baseline.
A focused physical assessment zeros in on the acute problem. You assess only the parts of the body that relate to that problem. It is usually performed when your patient’s condition is unstable, as a follow-up to a complete assessment, or when you are pressed for time.
eyes to inspect. ears to listen. hands to feel . Equipments.
The four techniques of physical assessment are inspection, palpation, percussion, and auscultation.
Do not rush the process; Take your time and really look at your patient. Perform inspection at every encounter with your patient. Be sure you have adequate lighting, and sufficiently expose the area being assessed. Be systematic in your approach, working from head to toe and noting key landmarks and normal findings. Use your patient as a comparative when possible. Ask yourself, “Does it look the same on the left side as the right?” Look for surface characteristics such as color, size, and shape. Ask yourself, “Are there color changes? Is the patient symmetrical?” Look for gross abnormalities or signs of distress.
Direct inspection involves directly looking at your patient. Indirect inspection involves using equipment to enhance visualization.
During palpation, you are using your sense of touch to collect data. Palpation is used to assess every system. It usually follows inspection. Palpation allows you to assess surface characteristics, such as texture, consistency, and temperature, and allows you to assess for masses, organs, pulsations, muscle rigidity, and chest excursion. It also lets you differentiate areas of tenderness from areas of pain.
Different parts of the hand are best suited for specific purposes For example, The dorsal aspect of the hand is best for assessing temperature changes , The ball of the hand on the palm and ulnar surface is best for detecting vibration and the finger Pads and tips are the most discriminating for detecting fine sensations, such as pulsations
Light palpation :Is applying very gentle pressure with the tips and pads of your fingers to a body area and then gently moving them over the area, pressing about 1⁄2 inch.Light palpation is best for assessing surface characteristics, such as temperature, texture, mobility, shape, and size. It is also useful in assessing pulses, areas of edema, and areas of tenderness.
Deep palpation is applying harder pressure with your fingertips or pads over an area to a depth greater than 1⁄2 inch. Deep palpation can be single-handed.
bimanual; When using the bimanual technique, feel with your dominant hand. You can place your other hand on top to help control your movements or to stabilize an organ with one hand while you palpate it with the other.
Deep palpation is used to assess organ size, detect masses, and further assess areas of tenderness. To assess for rebound tenderness, press down firmly with your dominant hand and then lift it up quickly.
Ballottement is a palpation technique used to assess a partially free-floating object.
Percussion is used to assess density of underlying structures, areas of tenderness, and deep tendon reflexes (DTRs). It entails striking a body surface with quick, lightblows and eliciting vibrations and sounds. The sound determines the density of the underlying tissue and whether it is solid tissue or filled with air or fluid.
Direct or immediate percussion is directly tapping your hand or fingertip over a body surface to elicit a sound or to assess for an area of tenderness. Direct percussion may be used instead of indirect percussion on an infant’s chest. It is also used to assess for sinus tenderness.
To perform indirect or mediate percussion , place your nondominant hand over a body surface, pressing firmly with your middle finger. Then place your dominant hand over it. Flexing the wrist of your dominant hand, tap the middle finger of your nondominant hand with the middle finger of your dominant hand. Do not rest your entire hand on the body surface because this dampens the sound. Keep only your middle finger on the body surface, and hyperextend it as you percuss. Tap lightly and quickly, removing your top finger after each tap.
Direct auscultation is listening for sounds without a stethoscope. indirect auscultation with a stethoscope.
Always have earpieces pointing forward to seal the ear canal. Warm your stethoscope. Work on the patient’s right side. This stretches your stethoscope across the patient’s chest and minimizes interference. Never listen through clothes. Make sure that the environment is quiet. If hair is a problem, wet it to minimize artifact. Use light pressure to detect low-pitched sounds Use firm pressure to detect high-pitched sounds. Close your eyes to help you focus. Learn to become a selective listener. Most of all—practice
Workfrom head to toe, and whenever possible, from side to side. Alwaysconsider the developmental stage of your patient. Also be aware of cultural influences that may affect the assessment and your findings.
Also be conscious of your nonverbal behavior; maintain a professional demeanor and caring attitude, and be sensitive to your patient’s needs. Explain what you are doing every step of the way, and encourage the patient to ask questions. Make sure that the examination room is quiet and private and that you will not be interrupted. The room also needs to be warm. Ask the patient if she or he needs to void before the examination.
Provide privacy to allow your patient to change into a gown if needed. While she or he is changing into a gown, assemble all your equipment and make sure that everything is in working order. Designate one area as clean for the unused equipment and one area as dirty for the used equipment. If your patient is uncomfortable removing all of her or his clothing, allow her or him to leave undergarments on and remove them only during the parts of the examination when it is necessary.
Wash your hands before you begin, and wear gloves if the possibility of exposure to blood or body fluids exists. Drape your patient. Work from the right side when possible, and expose only the area being assessed. During the examination, you will use all four techniques of physical assessment. If your patient has identified an area of concern, begin there; otherwise, proceed from head to toe. Do not rush. Pay attention to your patient’s responses, both verbal and nonverbal, and respond accordingly.
Do not rush. Look for developmental changes. Do not assume. For example, your patient may be elderly, but that does not mean he or she is hard of hearing. Conserve your patient’s energy by minimizing position changes and helping her or him change positions as needed. Allow enough time for patient to respond to questions or instructions.
Identify the disability. Focus on the patient’s functional ability and mental capacity. Modify your assessment based on the patient’s assets and needs. For example, if he or she is deaf, you may need to write instructions or have someone available who can sign. Be alert and sensitive to your patient’s needs, especially if she or he is unable to communicate verbally.