The document describes the process of conducting a physical examination. It defines physical examination and outlines the basic techniques used, including inspection, palpation, percussion, and auscultation. It provides examples of common equipment used and examines different body systems. The document also discusses ensuring patient privacy and comfort during the examination.

1. PHYSICAL EXAMINATION
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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
 Create Rapport with the client to make for a more
relaxed examination for both the nurse and client
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4.  Cleanse your hands and follow the IP
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 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
 Stethoscopes-used to auscultate sounds within
the body that are not audible with a necked ear
 Sphygmomanometer-Used to measure arterial
blood pressure
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6.  Pulse oximeter-used to estimate arterial
oxygen saturation in the blood
 Measuring scales-Used to measure body
weight and height
 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
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7.  Penlight-to provide focused light source to
facilitate inspection.
 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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8.  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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9.  Skin
 Head and neck
 Thorax and lungs
 Breasts
 Cardiovascular system
 Abdomen
 Genitalia
 Neurologic system
 Musculoskeletal system
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10.  NOTE: The assessment may be modified based on
the person’s presenting problem, age, general
condition, and other factors.
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11.  Data for physical assessment are collected using
four basic assessment techniques: Inspection,
Palpation, Percussion and auscultation.
 Before proceeding with the four techniques, a
general survey of the patient must be conducted.
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12. APPEARANCE
 Observe body build, height and weight in relation
to 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
 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
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13.  MENTAL STATUS
 Assess client’s attitude
 Note the client’s affect/mood; assess
appropriateness of the client’s responses
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14. Inspection: it is using the senses of vision,
smell, hearing to observe the condition of
body part.
 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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15.  Palpation: used to determine
roughness/smoothness Use of parts of the
hand to touch and fell for the following;
 Strength of pulses
(strong/weak/thready/bounding)
Temperature: warm/hot/cold
 Moisture (dry/wet/moist)
 Motion (stillness/vibration)
 Consistency of structures (fluid filled/solid)
 Shape (well defined/irregular)
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16.  Three different parts of the hand are used-
finger pads, ulnar/palmarsurface and dorsal
surface.
 Finger pads for fine discrimination: pulses,
texture, size, consistency, shape,
 Ulnar of palmar surface: vibrations, thrills and
fremitus
 Dorsal surface: temperature
 During palpation, touch should be gentle
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17.  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 possible
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18.  Three types of palpation to be used.
 Light palpation
 Deep palpation
 By manual palpation to palpate breast
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19.  The depth of the structure being palpated
and thickness of the tissues overlying it
determines the type of palpation
 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
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20.  Deep palpation is accomplished by using one or
both hands to press up to 4 cm to determine
organ size and contour.
 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 .
 This technique is used to assess the kidneys and
the uterus.
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22.  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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23.  Indirect percussion: Uses both hands
 is performed by placing the distal aspect of
the middle finger of the non-dominant hand
against the skin of the organ being percussed
(this finger is also referred to as the
pleximeter) The other fingers of the non-
dominant and are spread apart and slightly
elevated off the client’s skin so that they do
not dampen the vibrations.
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24.  Percuss 2 0r 3 times an area before moving
to another.
 percussion of the lungs .

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26.  Sounds detected:
 Resonance: over part air or solid
 Hyperesonance: heard over mostly air
 Tympanic: gastric pupple
 Dullness: solid tissue
 Flatness: over very dense tissue (bone,
sternum, muscle, thigh
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27.  Auscultation: Act of listening to sounds
within the body.
 A stethoscope is used during auculatation
to block out some extraneous sounds when
evaluating the condition of the heart, blood
vessels and intestines etc.
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28.  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 ausculatating, hold the diaphragm firmly
against the 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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30. 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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31. 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 thorax, lungs, breasts, axillae,
heart, vital signs and upper extremities
 Supine for the head, neck, anterior thorax,
lungs, breasts , axillae, heart, abdomen,
extremities and pulses
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32.  Dorsal recumbent, for the head, neck,
anterior thorax, lungs breasts, axillae, heart
and abdomen
 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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