The document discusses the components and process of conducting a general physical examination. It defines a general physical exam, outlines the learning objectives, and describes the purpose as confirming overall health or diagnosing medical issues. Key steps include preparing the patient, using various examination positions and techniques like inspection, palpation, percussion and auscultation, and assessing all body systems. Safety, equipment needs, and accommodating different populations are also reviewed.

1. © 2009 The McGraw-Hill Companies, Inc. All rights reserved
General Physical Examination
By:
Hamza oumer.

2. © 2009 The McGraw-Hill Companies, Inc. All rights reserved
38-2
Learning Outcomes
 Define and state the purpose of a general physical examination.
 Explain safety precautions used during a general physical
examination.
 Outline the steps necessary to prepare the patient for an
examination.
 Describe how to position and drape a patient in each of the ten
common examination positions.
 Explain ways to assist patients from different cultures, patients
with disabilities, pediatric patients, and pregnant women.
 Identify and describe the six examination methods used in a
general physical examination.
 List the components of a general physical examination.

3. © 2009 The McGraw-Hill Companies, Inc. All rights reserved
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Definition of General Physical Examination
 Physical examination: is a systematic data collection
method that use observational skills (i.e the sense of
sight, hearing, smell, and touch) to detect health
problem

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Overview of Physical Examination
 It is always advisable to follow the points below
while examining the patient:
 Examination should take place with good lighting and in a
quite environment.
 It is advisable to examine a supine patient from the patient’s
right side.
 By words or gestures, be as clear as possible in your
instructions.
 If possible try to demonstrate the patient what to do rather than
giving verbal instructions alone.
 Keep the patient informed as you proceed with your
examination.
 While examining the patient, it is helpful to move “from head
to toe.”

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Purpose of General Physical
Examination
 To confirm an overall state of
health
 Baseline values for vital signs
 To diagnose a medical
problem
 Usually focuses on organ
system based on patient’s chief
complaint

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Purpose of General Physical
Examination (cont.)
 Clinical diagnosis
 Based on signs and symptoms of a disease
 Sign – objective information that can be detected
 Symptom – subjective information from the patient
 Laboratory and diagnostic tests
 Confirm clinical diagnosis
 Aid in forming differential diagnosis
 Aid in developing a prognosis
 Formulate a treatment plan and/or drug therapy

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Equipment and Supplies Used for a
Physical Examination
 Cotton balls
 Assess sensory system for light touch
 Gloves
 Reduce risk for transmission of microorganisms
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By Hamza U.

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Equipment and Supplies Cont’d…
 Laryngeal mirror
 To inspect pharynx and oral cavity
 Ophthalmoscope
 To visualize the eye’s interior
 Otoscope
 Special ear speculum that attaches to an ophthalmoscope
to visualize external and middle ear (eardrum)
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By Hamza U.

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Equipment and Supplies Cont’d…
 Penlight
 Flashlight to test pupillary
reaction to light and third,
fourth, and sixth cranial
nerves
 Percussion hammer
 to test reflexes
 Safety pin
 to assess pain, sensory
system
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By Hamza U.

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Equipment and Supplies Cont’d…
 Tape measure
 to measure circumference
 Tongue depressor
 to inspect oral cavity and
stimulate gag reflex to assess
ninth and tenth CN
 Tuning fork
 to perform Rine test to assess
eighth (acoustic) cranial nerve
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By Hamza U.

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Equipment and Supplies Cont’d…
 Lubricant
 Facilitates insertion of
instruments into body
cavities
 Drape
 Covers exposed body
parts
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By Hamza U.

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Safety Precautions
 OSHA standards and guidelines
 Protect employee
 Make workplace safe
 CDC guidelines
 Protect patients and health-care workers

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Safety Precautions (cont.)
 Hand washing
 Before and after each patient contact
 Before and after each procedure
 Wear gloves if there is probability of contact with
 Blood  Nonintact skin
 Body fluids  Moist surfaces

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Safety Precautions (cont.)
 Wear a mask if there is any possibility of
exposure to an infectious disease transmitted
by airborne droplets
 Isolation precautions
 Personal protective equipment
 Keep patients with possible infections separated
from other patients

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Safety Precautions (cont.)
 Discard all disposable equipment and supplies
appropriately
 Clean and disinfect the exam
room after each patient
 Sanitize, disinfect, and sterilize
equipment appropriately

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Preparing the Patient for an
Examination
 Emotional – explain exactly what will occur
 Physical – offer the bathroom and instruct the patient
on how to disrobe and don an exam gown
 Positioning and draping – help patient assume
needed exam position and drape to provide privacy

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Preparing the Patient for an
Examination: Positioning and Draping
 Positions facilitate nurse's examination
 Assist the patient to appropriate position
 Make as comfortable as possible
 Cover with appropriate drape
 Keep patient warm
 Maintain privacy / modesty

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 Positions
 Sitting
 Supine /
recumbent
 Dorsal recumbent
 Lithotomy
 Trendelenburg’s
 Fowler’s
 Prone
 Sims’
 Knee-chest
 Proctologic
Preparing the Patient for an
Examination: Positioning and Draping (cont.)

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 Sitting  Supine / Recumbent
 Dorsal recumbent
Preparing the Patient for an
Examination: Positioning and Draping (cont.)

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 Lithotomy
 Trendelenburg’s
 Fowler’s
 Prone
Preparing the Patient for an
Examination: Positioning and Draping (cont.)

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 Sims’
 Knee-Chest
 Proctologic
Preparing the Patient for an
Examination: Positioning and Draping (cont.)

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 Patients from different cultures
 Avoid stereotyping
 Avoid making judgments
 Patients with disabilities
 Provide extra assistance
as needed
 Ask for assistance with
patient transfers
Preparing the Patient for an
Examination: Special Considerations

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 Children
 Location of exam based on age and
ability to cooperate
 Percussion and auscultation done
first and painful areas examined last
 Examine older children’s genitalia
last as it is embarrassing for them
Preparing the Patient for an
Examination: Special Considerations (cont.)

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 Pregnant women
 Position considerations
 Assist as necessary
 Ensure comfort
 After lying flat, have
patient sit on the exam
table before standing
 Avoids Dizziness or
hyperventilation
Preparing the Patient for an
Examination: Special Considerations (cont.)

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Techniques of Physical Examination
 The art of physical examination is based on the
following four basic techniques
1. Inspection
2. Palpation
3. Percussion
4. Auscultation
5. Mensuration
6. Manipulation

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1. Inspection
 It is the act of systematic and deliberate visual
observation to determine the functional statues of
body part
 During inspection
 Expose the body
 Always look before touch
 Use good light
 Provide warm room
Examination Techniques (cont.)

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2. Palpation
 It is the act of touching and filling the body part with
hands in order to determine texture, temperature,
moisture, motion, and consistency of structure
 Palpation can be
 Light palpation: - feeling superficial abnormality
 Deep palpation: - feeling deep abnormality
 Bimanual palpation: - used to assess deep
abnormality and internal organs
Examination Techniques (cont.)

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3. Percussion
 It is the act of tapping portions of the body to elicit
sound that vary with the density of the underline
structure
 Percussion can be
 Direct percussion: - direct tap body part with one
or two finger tips to elicit tenderness or pain
 Indirect percussion indirectly tapping on body
organ to illicit different sounds
Examination Techniques (cont.)

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 Percussion Notes
 Tympani: - normal sound heard on air filled GIT or puffed
cheeks
 Resonance:- sound heard on normal lung
 Hyper resonance:- sound heard on air filled lung
 Dullness: - sound heard on body organ like heart, liver,
spleen
 Flatness: - sound heard on muscle and bone
Examination Techniques (cont.)

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4. Auscultation
 It is act of listening for various breath,
heart, blood vessels, and bowel sound
using a stethoscope.
 Diaphragm part of the stethoscope is used
to detect high pitched sound like heart, lung,
and bowel sounds. when you use the
diaphragm press firmly
 Bell is used to detect low pitched sound like
abnormal heart sound and bruits. When you
use the bell press lightly
Examination Techniques (cont.)

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Examination Techniques (cont.)
6. Manipulation
 Systemic moving of a
patient’s body parts
 Range of motion of
joints
5. Mensuration
 Measuring
 Height and weight
 Length or diameter of
extremity
 Growth of uterus
during pregnancy

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Components of the General Physical
Examination
The components of comprehensive examination are:
 General appearance:
 Is the patient acutely sick, chronically sick looking or not
sick looking at all?
 Is the patient in cardio respiratory distress or not?
 Vital signs:
 Pulse (rate, volume, character, radio femoral delay)
 Blood pressure (specify arm and the position it was taken)
 Respiratory rate
 Temperature (Specify the location it was taken)
 Weight and Height

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 H.E.E.N.T (head, eye, ear, nose, mouth and throat)
 Lymph glandular system
 Respiratory system
 Cardiovascular system
 Gastro intestinal system
 Genito urinary system
 Integumentary system
 Mesculo skeletal system
 Central nervous system.
Components of the General Physical
Examination (cont.)

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Completing the Examination
 Assist patient to a
sitting position
 Allow the patient to
perform any necessary
self-hygiene measures
 Additional tests or
procedures