ROALTY TELEVISION

1. PHYSICAL EXAMINATION
LECTURE: MR JONES H.M- MBA/DMS
2/28/2021
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2. DEFINITION
“Process of collecting observable data by the
nurse using techniques of inspection, palpation,
percussion and auscultation, Wilson and
Giddens 2005.
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3.  A complete physical examination is conducted
normally from head moving towards the toes.
However the procedure may vary depending on
the purpose of the visit and the client’s
condition.
 Before starting, do the following:
Collect the equipment
Explain to the client what you will be doing and
how long it will take
and client 2/28/2021
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4. Create Rapport with the client to make for a
more relaxed examination for both the nurse
Cleanse your hands and follow the infection
prevention techniques through out the
examination.
Ensure that client’s privacy is protected; draw
the curtains if using a semi-private room
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5. EQUIPMENT FOR PHYSICAL
EXAMINATION.
 Equipment is used to facilitate the collection of
data
 Type varies depending on the type of
examination and problem being faced.
 Some examples are:
Thermometers-used to measure body
temperature
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6.  Stethoscopes-used to auscultate sounds within
the body that are not audible with a necked ear
 Sphygmomanometer-Used to measure arterial
blood pressure.
Pulse oximeter-used to estimate arterial oxygen
saturation in the blood
Measuring scales-Used to measure body weight
and height
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7. Snellen’s Chart- used to test visual acuity and
colour perception
Ophthalmoscope-used to inspect internal
structures of the eye
Otoscope-used to inspect the external auditory
canal and the tympanic membrane.
Penlight-to provide focused light source to
facilitate inspection.
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8. Ruler and tape measure-Used to measure the
size of body organs or size of skin lesions
Nasal speculum-facilitate inspection of interior
surface of the nose
Tuning fork-for assessing hearing acuity
Percussion or reflex hammer- used to elicit
reflex response
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9.  Goniometer-Helps to determine the degree of
flexion or extension of the joint
 Calipers-used to measure the thickness of
subcutaneous tissue to estimate the amount of
body fats
 Vaginal speculum- to facilitate the inspection of
vaginal wall and the cervix
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10. Sequencing of the Assessment
 Skin
 Head and neck
 Thorax and lungs
 Breasts
 Cardiovascular system
 Abdomen
 Genitalia
 Neurologic system
 Musculoskeletal system
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11.  NOTE: The assessment may be modified based
on the person’s presenting problem, age, general
condition, and other factors.
Four basic techniques for physical
assessment
Data for physical assessment are collected using
four basic assessment techniques:
1) Inspection
2) Palpation,
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12. 3) Percussion
4) Auscultation.
 Before proceeding with the four techniques, a general
survey of the patient must be conducted from head to
toe. Example
GENERAL SURVEY
APPEARANCE
 Observe body build, height and weight in relation to
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13. client’s age, life style and health.
 Observe the client’s overall hygiene and
grooming, relate these to person’s activities
before the assessment
Note body and breath odour in relation to
activity level
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14.  Observe sign of distress in posture eg bending
over due
 to abdominal pains and facial expression
 Note signs of health or illness eg skin colour or
breathing
MENTAL STATUS
 Assess client’s attitude
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15.  Note the client’s affect/mood; assess
appropriateness of the client’s responses
TECHNIQUES
Inspection- is observation with a purpose.
 The senses involved in this technique are vision,
hearing, and smell.
 It is most important basic techniques
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16.  It is continuous process and actually begins
during history taking and continues while other
techniques are being used.
 Start with general to specific, a general picture is
observed during general survey and a specific
inspection parts of the body is done.
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17.  Expose body part
 Always look before touching
 Use good lighting
 Provide warm room.
 You observe color, size, location, texture,
symmetry, odors, sounds.
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18. 2) Palpation
 Used to determine roughness/smoothness.
 Use of parts of the hand to touch and feel for
the following;
 Strength of pulses
(strong/weak/thready/bounding),
 Temperature: warm/hot/cold
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19.  Moisture (dry/wet/moist)
 Motion (stillness/vibration)
 Consistency of structures (fluid filled/solid)
 Shape (well defined/irregular)
 The examiner’s hands should be warm
 The client must be relaxed.
 Muscle tension can hamper the results of
palpation.
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20.  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 examiner must also bear in mind that the
different parts of the hands differ in sensitivity.
 Various parts of the hand are therefore utilized
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21. for palpating different parts of the body.
Three different parts of the hand are used-
finger pads, ulnar/palmar surface and dorsal
surface.
Finger pads for fine discrimination: pulses,
texture, size, consistency, shape,
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22. Ulnar of palmar surface: vibrations, thrills and
fremitus
Dorsal surface: temperature
During palpation, touch should be gentle
Hands should be warm and nails short
Explain the purpose of the touch
Wear gloves when palpating mucous membranes
and areas where contact with body fluids is
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23. possible.
Three types of palpation to be used.
 Light palpation
 Deep palpation
 By manual palpation to palpate breast
 The depth of the structure being palpated and
thickness of the tissues overlying it determines
the type of palpation.
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24.  Light palpation is accomplished by palpating to a
depth of 1cm and is used to assess the skin
pulsations , surface skin texture, moisture and
tenderness
 Deep palpation is accomplished by using one or
both hands to press up to 4 cm to determine organ
size and contour.
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25.  Light palpation should always precede deep
palpation
 Bimanual technique uses both hands, one
anterior called sensing hand and one posterior
called to entrap an organ or mass between the
finger tips to assess size and shape .
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26.  This technique is used to assess the kidneys and
the uterus.
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28. 3) PERCUSSION
 An assessment method in which a portion of the body
Tapped to elicit tenderness or sounds that vary with
density of underlying structure
 There are two types;
 Direct percussion: percussion of the sinus to elicit
tenderness or pain directly tap the part with one or two
fingertips.
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29. Indirect percussion - two fingers are used,
finger percussing is called the plexor and one
being percussed is the pleximeter.
 The pleximeter (middle finger) is placed on the
body surface- palm of the hand and other
fingers touching the body.
 The tip of the plexor (middle finger of the
other hand) is now used to percuss on , or distal
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30. to, the interphalageal joint of the pleximeter
 Percuss 2 0r 3 times an area before moving to
another.
 percussion of the lungs .
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32.  Sounds detected:
 Resonance: over part air or solid
 Hyperesonance: heard over mostly air
 Tympanic: gastric supple
 Dullness: solid tissue
 Flatness: over very dense tissue (bone, sternum,
muscle, thigh
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33. 4) Auscultation: Act of listening to sounds
within the body.
 A stethoscope is used during auscultation to
block out some extraneous sounds when
evaluating the condition of the heart, blood
vessels and intestines etc.
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34.  Diaphragm and bell: diaphragm for detecting
high pitch sounds (breath sounds, normal heart,
bowel sound)
 Bell: low pitch sounds (abnormal extra heart
sounds, heart murmur and carotid pulse).
 When auscultating, hold the diaphragm firmly
against the
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35. client’s skin stabilizing it between the index and
middle finger.
 Ensure that you warm the stethoscope before
placing it on the client
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37. 1.Reflect on your approach to patient
 identify self, be calm , organized, competent
2. Adjust the light and environment
3. Determine the scope of examination
4. Choose the sequence of examination
5. Observe the correct examining position and
handedness
6. Make patient comfortable
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38.  The position of the client during physical
examination depends on the type of
examination to be done and the condition of
the client.
 The following positions can be assumed to
assess the mentioned areas:
Sitting position for the head, neck, posterior and
anterior
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39. thorax, lungs, breasts, axillae, heart, vital signs
and upper extremities
Supine position for the head, neck, anterior
thorax, lungs, breasts , axillae, heart, abdomen,
extremities and pulses
Dorsal recumbent, for the head, neck, anterior
thorax, lungs breasts, axillae, heart and abdomen
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40. Lithotomy for female genitalia and genital tract
Sims’ for rectum and vagina
Prone for muscloskeletal
Knee-chest for rectum
The client should be drapped as appropriate as
possible.
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41. THANKS =======END
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