The document discusses physical assessment, which involves systematically collecting objective information about a patient through examination techniques like inspection, palpation, percussion, and auscultation. It outlines the purpose, indications, techniques, and safety precautions for each examination method. It also discusses positioning and draping patients, necessary equipment, and preparing patients for examination to make them comfortable both emotionally and physically.

1. PHYSICAL ASSESSMENT
Nuzhata Nazir
Tutor/Demonstrator
GMC Anantnag

3. Physical assessment
 It is the systematic collection of objective information that is directly observed
or is elicited through examination techniques.
 Physical examination involves the use of ones senses to obtain information
about the structure and function of an area being observed or manipulated.
 It the thorough inspection or a detailed study of the entire body or some parts
of the body to determine the general physical or mental conditions of the body.

4. Purpose
 To understand the physical and mental well-being of the clients.
 To detect disease in its early stage.
 To determine the cause and extent of disease.
 To understand any change in the condition of diseases, any improvement or regression.
 To determine the nature of the treatment or nursing care needed for the client.
 To safeguard the client and his family by noting the early signs especially in case of a
communicable disease.
 To contribute to the medical research.
 To find out whether the person is medically fit or not for a particular task.

5. Indication of phisical examination

6.  Inspection
 Palpation
 Percussion
 Auscultation
 olfaction

8. Inspection
 Systematic Visual examination of the patient or it is a process of performing deliberate purposeful observations in a
systematic manner.
 It involves observation of the colour, shape, size, symmetry, position and movements.
 Findings that may be significant
1. overall appearance of health or illness
2. Grooming and personal hygiene
3. Signs of distress
4. Facial expression and mood
5. Eye gaze
6. Body language
7. Body position
8. Skin color
9. Odor
 Inspection is the first method used in examination of specific area. The chest and abdomen are inspected before
palpation and auscultation.

9. Palpation
 A technique in which the hands and fingers
are used to gather information by touch.
 It uses sense of touch
 Palmar surface of fingers and finger pads
are used to palpate for
-Texture -vibrations -symmetry
-Turgor -size
-position -consistency
-Masses -Fluid
-Assess skin temperature
 Client should be relax and positioned
comfortably because muscle tension during
palpation impair its effectiveness.
 Asking the client to take deep and slow
breath.

12. Types of palpation
 Light palpation
 Deep palpatipn
 Bimanual palpation

13. Light palpation
 The nurse apply tactile pressure slowly,
gentely and deliberately.
 The nurses hand is placed on the part to
be examined and depredsed about 1-
2cm.

14. Deep palpation
 It is done after light palpation
 It is uses to detect abdominal massess.
 Technique is similar to light palpation
except that the finger are held at a
greater angle to the body surface and the
skin is depressed about 4-5 cm.

15. Bimanual palpation
 It involve using both hand to trap a structure
between them. This technique can be used
to evaluate spleen, kidney, breast, uterus
and ovary.
 Sensing hand--- Relax and place lightly over
the skin.
 Active hand ---Apply pressure to the sensing
hand.

17. Palpation Cont.….
 The dorsum (back) surfaces of the hand and fingers are used to measure temperature.
 The palmar (front) surfaces of fingers and finger pads are used to assess texture, shape,
fluid, size, consistency and pulsation.
 Vibration is palpated best with the palm of the hand. (Tactile fremitus)
 Symmetry-Grab the lower hemithorax on either side of axilla and gently bring your thumbs
to the midline.

19. Percussion
 Percussion is the act of striking one object against another
to produce sound.
 Percussion involve tapping the body with the fingertips.
 It is used to outline the size of an organ such as bladder or
liver.
 It is also used to determine if a structure is air-filled,
fluid-filled or solid.
 The sound waves produced by the striking action over
body tissues are known as percussion tones or percussion
notes.
 The degree to which sound propagates is called
resonance.

20. Direct/immediate
percussion
 It can be performed by striking the
surface directly with the fingers of the
hand.
 Used mainly to evaluate the sinus or an
infant thorax.

21. Indirect/ mediate
percussion
 It can be performed by using the finger on one
hand as a plexor (striking finger) and the middle
finger of the other hand as a pleximeter (the
finger being struck).
 Used mainly to evaluate the abdomen or thorax

22. Fist percussion
 It involves placing one hand flat against
the body surface and striking the back of
the hand with a clenched fist of the other
hand.
 Used to evaluate the back and kidney for
tenderness.

23. Percussion tones/notes
 Percussion produce five characteristic tones:
1. Tympanic (abdomen)
2. hyper-resonant (hyper-inflated lung tissue)
3. Resonant (normal lung)
4. Dull (liver)
5. Flat (flat)

24. Sounds produced by percussion
 Sound: Tympany
 Intensity: Loud
 Pitch: High
 Duration: Moderate
 Quality: Drum-like
 Common location: Air containing space, enclosed area, gastric air bubble,
puffed out cheek.

25. Sounds produced by percussion
 Sound: Resonance
 Intensity: Moderate to loud
 Pitch: Low
 Duration: Long
 Quality: Hollow
 Common location: Normal lungs

26. Sounds produced by percussion
 Sound: Dull
 Intensity: soft to moderate
 Pitch: High
 Duration: Moderate
 Quality: thudlike
 Common location: Liver

27. Sounds produced by percussion
 Sound: Flatness
 Intensity: soft
 Pitch: High
 Duration: short
 Quality: Flat
 Common location: bones

28. Auscultation
Listening to body
sounds using a
stethoscope

29. Auscultation
 Auscultation is listening to sound produced by the body.
__ Body sounds produced by movement of fluids or gases in
patients organs or tissues.
 Best performed in a quiet environment
 Requires a stethoscope
 The heart and blood vessels are auscultated for circulation of
blood
 the lungs are auscultated for moving air (breath sounds)
 The abdomen is auscultated for movement of gastrointestinal
contents (bowel sounds)

30. Auscultation sounds
 Through auscultation the nurse note the following characteristics of sound.
1. Pitch/Frequency or the number of oscillation generated per second by a vibrating object-
ranging from high to low.
2. loudness- Ranging from Soft to loud
3. Quality- Blowing or Gurgling
4. Duration –Length of time that sound vibration last-Short/medium/ long.

32. olfaction
 While assessing a client the nurse should be
familiar with the nature and source of body
odors.

33. MANIPULATION
 It is the moving of a part of the body to note its flexibility.
 Limitation of movement is discovered by this method.

34. TESTING OF THE REFLEXES
 The response of the tissues to external stimuli is tested by means of a
 Percussion hammer
 Safety pin
 Wisp of cotton
 Hot and cold water

35. Safety Precautions
 Aseptic hand washing
 Before and after each
patient contact
 Before and after each
procedure
 Wear gloves if there may be contact with
 Blood – Nonintact skin
 Body fluids – Moist surfaces
 Also when handling specimens

36. Safety Precautions (cont.)
• Respiratory hygiene/cough etiquette
• Wear a mask to prevent exposure to an infectious
disease transmitted by airborne droplets
• Isolation precautions – personal protective
equipment ----- use gloves; apron; mask; gown

37. 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

38. Environment
 Privacy
 Well equipped examination room
 Adequate lighting
 Sound proofed room
 Comfort environment
 Examination table

39. Positioning and Draping
 Proper patient position facilitates the examination
 Assist the patient to appropriate position
 Make as comfortable as possible
 Cover with appropriate drape
 Keep patient warm
 Maintain privacy/modesty

40. Positioning and Draping
Positions used during nursing assessment, medical examinations, and during diagnostic
procedures:
1. Sitting
2. Standing
3. Supine
4. Prone
5. Sims
6. Lithotomy
7. Dorsal recumbent
8. Knee-chest
9. Fowlers
10. proctologic

43. Positioning and Draping (cont.)
Sitting Supine/recumbent

44. Dorsal recumbent
Lithotomy
Positioning and Draping (cont.)

45. Positioning and Draping (cont.)
Prone Knee-Elbow

46.  Fowler’s  Sims’
Positioning and Draping (cont.)

47. Positioning and Draping (cont.)
Proctologic

48. EQUIPMENTS

49. preparation of the Equipment
 All the articles needed for the physical examination are kept ready for the examination at hand.
Articles Required Purpose
sphygmomanometer To measure B.P.
stethoscope To listen to the body sounds.
Fetoscope To listen the F.H.S.
T.P.R. Tray To assess the vital signs.
Tongue depressor To examine the mouth and throat.
pharyngeal retractor To examine the pharynx
Laryngoscope To examine the larynx.
Tape measure To measure height, circumference of the head and abdomen
Flash light. To visualize any part
Weighing machine and Height scale To check the weight and height.
Ophthalmoscope To examine the inner part of the eyeball.
Otoscope To examine the ear.

50. Articles Required Purpose
Tuning fork To test the hearing.
Nasal speculum To examine the nostrils.
Percussion hammer, safety pins, cotton wool, cold and
hot water in test tubes
To test reflexes.
Vaginal speculum To examine the genitals in women
Proctoscope To examine the rectum,
Gloves To examine the pelvis internally.
Sterile specimen bottles, slides, cotton
applicators
To collect the specimens if necessary.

51. Articles required
1. Screen to provide privacy
2. Bowl for antiseptic lotion
3. Kidney tray and paper bag
4. Patient gown
5. Bath blanket to cover the patient
6. Draw sheet to cover patients chest
7. Drum containing test tube, gauze piece, cotton swab, specimen bottle,
swabsticks

53. Preparing the Patient for an
Examination
• Emotional preparation
– Explain exactly what will occur and what
they will feel
– Use simple direct language
• Physical
– Offer the bathroom
– Ask the patient to disrobe and put on an
exam gown or cover with a drape
– Be aware of modesty and comfort

56. Vitals signs

65. General Examination or Head to Toe Examination
 The examination is carried out in an orderly manner focussing upon one area of the body at a time.
 The observation of the client starts as the client walks into the examination room, e.g.. a limp may be
noted as the client walks in.
 The following observations are made:
BASELINE DATA
 Weight
 Height
 Abdominal girth
 Temperature
 Pulse
 Respiration
 Blood pressure

66. General Appearance
Nourishment: Well nourished or under nourished
Body build: Thin or obese.
Health: Healthy or unhealthy
Activity: Active or dull (tired).
Mental Status
Consciousness: Conscious, unconscious, delirious,
talking, incoherently.
Look: Anxious or worried, depressed etc.

67. Posture
Body curves: Lordosis, kyphosis, scoliosis
Movement: Any limp.
Height and Weight
Skin Conditions
Colour: Pallor, jaundice, cyanosis flushing etc.
Texture: Dryness, flaking, wrinkling or excessive
moisture.
Temperature: Warm, cold and clammy.
Lesions: Macules, papules, vesicles, wounds etc

68. Head and Face
Shape of the skull and fontennels (noted in the new-borns) Skull
circumference
Scalp: Cleanliness, condition of the hair, dandruff, pediculi, infections
like ringworm,
Face: Pale, flushed, puffiness, fatigue, pain, fear, anxiety. enlargement
of parotid glands etc
Eyes
Eyebrows: Normal or absent.
Eye lashes: Infection, sty.
Eyelids: Oedema, lesions, ectropion (eversion), entropion (inversion).

69. Eyeballs: Sunken or protruded
Conjunctiva: Pale, red, Purulent
Sclera: Jaundiced
Cornea and iris: Irregularities and abrasions.
Pupils: Dilated, constricted, reaction to light.
Lens: Opaque or transparent
fundus: Congestion, haemorrhagic spots.
Eye muscles: Strabismus (squint).
Vision: Normal, myopia (short sight), hyperopia
(long sight)

70. Ears
External ear: Discharges, cerumen obstructing the ear passage.
Tympanic membrane: Perforations, lesions, bulging.
Hearing: Hearing acuity.

71. Rinne test
 The Rinne test is conducted by placing a tuning fork on the
mastoid bone and then adjacent to the outer ear.
 Air conduction is better than bone conduction. The patient
should be able to hear the sound of the tuning fork adjacent to
their ear, persist for approximately twice as long as the sound
they heard over their mastoid process. This is considered a
"positive test.
Weber’s test
 Weber's test is performed by striking the
tuning fork and placing it against the middle
of the forehead. Ask the patient if the tone
is equal in both ears. Diminution in the
affected ear indicates sensorineural hearing
loss.

72. Nose
External nares: Crusts or discharges.
Nostrils: Inflammation of the mucus
membrane, septal deviations.

73. Mouth and Pharynx
Lips: Redness, swelling, crusts, cyanosis, angular
stomatitis.
Odour of the mouth: Foul smelling
Teeth: Discolouration and dental caries.
Mucus membrane and gums: Ulceration and
bleeding, swelling, pus formation.
Tongue: Pale, dry, lesions, sords, furrows, tongue tie
etc.
Throat and pharynx: Enlarged tonsils, redness and
pus.

74. Neck
Lymph nodes: Enlarged, palpable.
Thyroid gland: Enlarged.
Range of motion: Flexion, extension and rotation.

75. Chest
Thorax: Shape, symmetry of expansion, posture.
Breath sounds: Sigh, swish, rustle, wheezing,
crepitations, pleural rub etc.
Heart: Size and location, cardiac murmurs.
Breasts: Enlarged lymph nodes.

76. Abdomen
Observation: Skin rashes, Scar, hernia, ascites distension,
pregnancy etc,
Auscultation: Bowel sounds, foetal heart sounds.
Palpation: Liver margin, palpable spleen, tenderness at the area
of appendix, inguinal hernias.
Percussion: Presence of gas, fluid or masses.
Extremities
Movement of joints, tremors, clubbing of fingers, ankle oedema,
varicose veins, reflexes, ROM etc.
Back
In a standing position spine is examined for abdominal
curvature.
The fingers are moved over the spine to detect Spina bifida in
newborns.

78. Genitals and Rectum
Genitalia is examined for any abnormality
Inguinal lymph glands - enlarged, palpable.
Patency of urinary meatus and rectum (in infants)
Descent of the testes (in infants).
Vaginal discharges.
Presence of sexually transmitted diseases.
Anus is observed for Haemorrhoids, fissures or cracks.
The rectum is palpated for the presence of masses on anterior or posterior wall.
Enlargement of the prostate gland.
Pelvic masses.

79. Neurological assessment
Reflexes
A reflex is an automatic response of the body to a stimulus. Percussion hammer and pin is used in testing reflexes.
 Biceps reflex
 Triceps reflex
 brachioradialis
 Patellar reflex
 Achilles reflex
 Plantar reflex
Coordination tests
 Finger to nose test
 Heel to shin test

80. Neurological assessment
Equilibrium tests
 Stand with eyes open and feet together
 Stand with eyes close and feet together
Tests for sensation:
 Touch: Test with the wisp of cotton
 Vibrations: Test with tuning fork
 Temperature discrimination: Tested with test tubes filled with hot and cold water.
Muscle strength: Tonicity and movement of the muscles.