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Physical assessment

Physical examination is a systematic method of collecting data about a patient's physical and mental state. It involves inspection, palpation, percussion, auscultation, and olfaction. Inspection involves visually examining the patient, palpation feels the body for abnormalities, percussion taps the body to determine underlying structures, auscultation listens to internal sounds using a stethoscope, and olfaction smells for characteristic odors that may indicate issues. The purpose is to understand a patient's well-being, detect diseases early, determine the cause and severity of issues, and identify needed treatment or care. The exam is performed through gentle, deliberate techniques respecting patient privacy and comfort.

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Physical Examination•
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METHODS OF PHYSICAL EXAMINATION
DEFINITION OF PHYSICAL EXAMINATION  Physical Examination is defined as a complete Assessment of a patient’s physical and mental status  Physical assessment is a systematic collection of objective information that is directly observed or elicited through examination technique.
DEFINITION OF PHYSICAL EXAMINATION •Physical examination is a systematic data collection method that uses the
PURPOSE OF PHYSICAL EXAMINATION • To understand the physical and mental well- being of the patient. • To detect disease in its early stage • To determine the cause and the extend of disease • To understand any changes in the condition of disease, any improvement or regression. • To determine the nature of the treatment or nursing care needed for the patient.
METHODS OF PHYSICAL EXAMINATION INSPECTION PERCUSSION PALPATION AUSCULTATION OLFACTION
DEFINITION • It is a deliberate, purposeful and systematic collection of data from the client through the visual examination (that is, assessing by using the sense of sight )
GUIDELINES OF INSPCTION • Make sure that adequate lighting is available ,either direct or tangential. • Uses direct light sources (eg., a penlight or lamp) to inspect body cavities. • Inspect each area for size, shape, color, symmetry, position, and abnormality.
GUIDELINES OF INSPCTION • Position and expose body parts as needed so all surfaces can be viewed but privacy can be maintained. • When possible, check for side-to-side symmetry by comparing each area with its match on the opposite side of the body
• Palpation is the process of using one's hands to check the body, especially while perceiving /diagnosing a disease or illness.
PURPOSE OF PALPATION • Examination of the body surface (skin, smoothness, dryness, irregularities etc…) • Examination of internal organs (shape, size, consistency etc…) • To look for abnormal resistances. • Detection of painful areas • To feel movement of fluids within the body.
PRINCIPLES OF PALPATION • Prepare for palpation by warming hands, keeping fingernails short, and using a gentle approach. • Palpation proceeds slowly, gently, and deliberately. • Encourage the patient continue to breath normally through out the palpation. • Ask the patient to point to more sensitive areas.
PRINCIPLES OF PALPATION • Ask the patient to point to more sensitive areas. • Watching for nonverbal signs of discomfort. • If the pain is experiencd during palpation discontinue the palpation immediately.
TYPES OF PALPATION • LIGHT PALPATION • DEEP PALPATION
LIGHT PALPATION A method of determining the outlines of organs or masses by lightly palpating the surface with the tip of a finger for 1 to 2 centimeter.
DEEP PALPATION • Deep palpation is used to feel internal organs and masses, usually pressing down 4-5 centimeters.
• Percussion is a method of tapping the skin with the fingertips to vibrate underlying tissues and organs, to determine the structure.
TYPES OF PERCUSSION Direct percussion Indirect percussion Fist percussion
Direct percussion:- It involve tapping lightly with the pad of the fingers directly on the client skin
Indirect percussion:- • It can be performed by using two finger left middle finger[Pleximeter finger] is placed over the area and its middle phalanx is tapped with the tip of the right middle finger or index finger [percussing finger]
Fist percussion:- • It involve placing one hand flat against the body surface and striking the back of the hand with a clenched fist of the other hand
• Auscultation is listening to the internal sounds of the body, usually using a stethoscope.
PURPOSE OF AUSCULATION • Auscultation is performed for the purposes of examining the circulatory and respiratory systems, as well as the gastrointestinal system. • Its helps to listening for body sounds typically from organs and tissues to assess their functions.
TYPES OF AUSCULTATION Direct auscultation Indirect Auscultation
Direct Auscultation • It involve listening to the client body sound without using any assistive instrument [eg wheezing, chest congestion]
Indirect Auscultation • Involve listening to the client body sound with the use of a stethoscope
• Another skill that used during assessment, certain alteration is body function create characteristic body odors, smelling can detect abnormalities that unrecognized by other means.
Assessment of characteristic odors: • Alcohol odor from oral cavity means ingestion of alcohol. • Ammonia from urine means urinary tract infection. • Body odor from skin, particularly in areas where body parts rub together means poor hygiene, excess perspiration (bromidrosis).
Assessment of characteristic odors: • Feces odor from wound site means wound abscess, but if this odor from vomitus this means bowel obstruction, and if the odor from rectal area this means fecal incontinence. • Foul–smelling stools in infant from stool means mal absorption syndrome. • Halitosis from oral cavity means poor dental and oral hygiene, gum disease.
Assessment of characteristic odors • Halitosis from oral cavity means poor dental and oral hygiene, gum disease. • Sweet, fruity ketone from oral cavity may be from diabetic acidosis. • Musty odor from casted body part means infection inside cast. • Fetid odor from tracheostomy or mucous secretions means infection of bronchial tree (pseudomonas bacteria).
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