Health Assessment presentation for Nursing and other health professionals.

1. INTRODUCTION
 Health assessment is an essential nursing function which provides
foundation for quality nursing care and intervention. It helps to
identify the strengths of the clients in promoting health.
 Health assessment also helps to identify client's needs, clinical
problems or nursing diagnoses and to evaluate responses of the
person to health problems and intervention.
 An accurate and thorough health assessment reflects the
knowledge and skills of a professional nurse.
 Assessment is a key component of nursing practice, required for
planning and provision of patient and family centered care.
 The registered nurse assesses, plans, implements and evaluates
nursing care in collaboration with individuals and the
multidisciplinary healthcare team so as to achieve goals and
health outcomes.

2. DEFINITION
Health assessment is a systematic, deliberative and
interactive process by which nurses use critical thinking to
collect, validate, analyze and synthesize the collected
information in order to make judgment about the health
status and life processes of individuals, families and
communities.
 Objective data in nursing is part of the health
assessment that involves the collection of information
through observations.
 In the healthcare environment, the senses of seeing,
hearing, smelling and touching are used to gather
information about the patient. The patient's behaviors,
actions, test results, measurements and the physical
examination are also included.

3. PURPOSE AND FACTORS AFFECTING HEALTH
ASSESSMENT
 To understand the physical and mental well being of
the patient.
 To detect disease in its early stage.
 To determine the cause and the extent of disease.
 To understand any changes in the condition of diseases,
any improvement or regression.
 To determine the nature of the treatment or nursing
care needed for the patient.
 To safeguard the patient 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.

4.  To gather information regarding client's health.

 To determine client's normal function.

 To organize the collected information.

 To confirm hypothesis growing out of the nurse's interview.

 To enhance investigation of nursing problems.

 To frame nursing diagnosis.

 It increases greater managing skill of handling patient's problem.

 To identify the health problems.

 To identify client's strengths.

 To identify need for health teaching.

5. Factors affecting health assessment:
 Physical setting
 Clients personality and behavior
 Communication skill
 Problem
 Nurses personality and behavior
 Nurses knowledge and skill

6. In planning and performing health assessment, the
nurse needs to consider the following:
 An accurate and timely health assessment provides
foundation for nursing care and intervention.
 A comprehensive assessment incorporates
information about a client's physiologic,
psychosocial, spiritual health, cultural and
environmental factors as well as client's
developmental status.

7.  The health assessment process should include data
collection, documentation and evaluation of the client's
health status and responses to health problems and
intervention.
 All documentation should be objective, accurate, clear,
concise, specific and current.
 Health assessment is practiced in all healthcare settings
whenever there is nurse-client interaction.
 Information gathered from health assessment should be
communicated to other healthcare professionals in
order to facilitate collaborative management of clients
and for continuity of care.
 Client's confidentiality should be kept.

8.  The nurse has the responsibility to carry out
health assessment on every person under his/her
care.
 The nurse should regularly perform focused
assessments in response to client needs.
 The nurse needs to obtain client's consent prior to
health assessment.
 The nurse should demonstrate a caring attitude,
respect and concern for each client when doing a
health assessment.
 The nurse has the responsibility in keeping
confidentiality about the data being collected from
his/her client.

9.  The nurse obtains information on a client using various
techniques and tools, such as history taking, physical
examination, reviewing clients' records and results of
diagnostic tests. He/She has to draw inferences from data
collected in order to make appropriate and sound clinical
judgement.
 The nurse has to acquire specialized skills and competence in
collecting accurate and relevant information on the patient's
health in performing health assessment in order to make
sound clinical decisions.
 The nurse should document the results of health assessment,
analyze the data collected, evaluate the client's response to
health problems and interventions, and provide feedback to
the client as appropriate.
 The nurse should continuously advance their competence in
health assessment throughout one's nursing career.
 The nurse who takes up an advanced practice role has the
responsibility to prepare himself/herself in order to perform
advanced and focused health assessment.

10.  The health assessment interview is initiated to
gather specific information regarding the patient
and the patient's health status.
 The patient interview may also serve to validate
other health-related data and identify the patient's
knowledge of his/her own health and illness status.
 The patient interview is very important, as it
provides the foundation for subsequent nurse-
patient interactions and for medical and nursing
interventions.

11.  Communication factors, which may affect the patient
interview, include active listening, nonverbal
communication, distance, and personal space. These factors
can either positively or negatively impact on the interview.
 Active listening, respecting social distance guidelines, and
personal space requirements may facilitate the patient
interview.
 It is essential for nurses to be cognizant of their nonverbal
behaviors, and that these behaviors are sending the intended
message.
 Nonverbal behaviors, such as lack of eye contact, fidgeting,
and yawning may indicate that the nurse or patient is not
actively participating in the interview process or that the
individual is uncomfortable with the topic being discussed.
 Effective interviewing techniques include the appropriate
use of open-ended and closed-ended questions, facilitation,
and silence.
 .

12.  The nurse uses listening responses to accurately
receive, process, and respond to patient messages.
 Examples of listening responses include making
observations, restating and reflecting, clarifying,
sequencing, encouraging comparisons,
summarizing, and interpreting.
 The nurse uses action responses to stimulate
patients to change their thinking or their behavior.
 Commonly used action responses include focusing,
presenting reality, confronting, informing,
collaborating, limit setting, and normalizing.
 Nonverbal techniques, which may be helpful in
interviewing a patient, include the use of touch and
demonstrating attentiveness

15. Active Listening
 Nurses must do more than simply listen when
conducting a health history assessment-they must
actively listen.
 Active listening involves fully comprehending what
a patient is communicating through both verbal and
nonverbal cues (such as body language), as well as
the patient's emotional state
 Complete concentration is essential during a
nursing assessment.
 Listen carefully; using verbal and nonverbal
prompts to encourage the patient to expand on
his/her symptoms and the circumstances
surrounding them.

16. Adaptive Questioning
 Adaptive questioning helps you encourage a patient to fully
communicate without interrupting the flow of his or her
narrative.
 Start with general questions, making them more specific as you
move through the interview.
 Health assessments in nursing require questioning that elicits a
graded response versus a yes or no reply.
 A series of questions, asked one at a time, often helps patients
open up, as does offering multiple choices for answers.
 Request additional information when necessary by asking the
patient to clarify their statements.
 Repeating his/her statements (a technique called echoing) is also
helpful, as is using verbal and nonverbal continuers, such as
nodding your head or saying things like "go on."

17. Nonverbal Communication
 Nursing assessments also require that you be in
tune with a patient's nonverbal communication,
such as posture, eye contact, facial expression, and
the like.
 Reading and understanding these nonverbal cues
help nurses understand patients more fully, and
using nonverbal communication of their own, such
as mirroring a patient's position or using therapeutic
physical contact.
.

18. Empathy, Validation, and Reassurance
 Empathy is key in nursing health assessments, as it
demonstrates that you understand and care about what
a patient is experiencing and helps establish a trusting
nurse-patient relationship.
 Empathic responses during a health history assessment
interview can be both verbal ("I understand") and
nonverbal (such as offering a tissue if the patient is
crying).
 Beyond being empathic, be sure to validate patients'
feelings to help reassure them that their emotions are
natural and reasonable and their problems are
understood and will be fully addressed

19. Transitions and Empowerment
 Health problems can elicit feelings of anxiety in
patients. One way to put their fears at ease is to use
transitions during their health history assessment to let
them know what they should expect next, such as a
change in subject matter or a physical examination.
 Patients also feel vulnerable when they are experiencing
health problems, making it essential to empower them
with the idea that their participation in the process and
working closely with their medical team can make a
positive difference in their outcomes.

20.  Assessment is "a dynamic and continuous process
of collecting, verifying, and organizing information
about a person within a particular context."
Or
 "The ongoing and continuous collection of data
about an individual's health state throughout all
the phases of the nursing process".

21. 1. Initial comprehensive assessment.
2. Ongoing or partial/shift
assessment.
3. Focused or problem-oriented
assessment.
4. Emergency assessment.
5. Time-lapsed assessment.

22. 1) Initial/ Comprehensive assessment
 Initial assessment is performed to evaluate the
client‘s health status on admission and to have a
baseline comprehensive data about the client. E.g.:
Nursing admission assessment.
 It Involves collection of subjective data about the
past health history, family history, and lifestyle and
health practices. As well as objective data gathered
during a step-by step physical examination.

23. 2) Ongoing or partial/shift assessment:
Partial assessment is performed at the commencement of every shift on every patient
and the collected data is used to develop a plan of care. The shift assessment
includes:
 Airway: noises, secretions, cough, artificial airway
 Breathing: bilateral air entry and movement, breathe sounds, respiratory rate,
rhythm, spontaneous/ supported/ ventilator dependent, oxygen requirement and
delivery mode.
 Circulation: pulses (rate, rhythm and strength); peripheral temperature, color
and capillary refill time; skin, lip, oral mucosa and nail bed color.
 Disability: mobility aids or transfer requirements, and prosthetics required.
 Focused: assessment of presenting problem(s) or other identified issues, e.g.
cardiovascular, respiratory, gastrointestinal, renal, etc.
 Pain: Faces, numeric scale, pain assessment tool.
 Hydration/Nutrition: Fasting, diet, oral, nasogastric, gastrostomy, jejunostomy,
IV fluids.
 Output: Urine, bowels, drains, losses, fluid balance.
 Risk: Pressure injury risk assessment, falls risk assessment, presence of
identification (ID) bands.

24. 3) Focused or problem oriented assessment:
 It is a detailed assessment of specific body
system(s) relating to the presenting problem of the
patient.
 In focused assessment, the assessor determines
whether the problems still exists and whether the
status of the problem has changed (i.e. improved,
worsened, or resolved).
 This may involve one or more body systems. e.g.,
cardiovascular, respiratory, neurological.

25. 4) Emergency Assessment:
 It is a very rapid assessment performed in a life
threatening situations in which the preservation of
life is the top priority.
 Emergency assessment focuses on airway,
breathing and circulatory problems (the ABCs).
Phases Of Assessment Process
1. Collecting data
2. Validating (verifying) data
3. Organizing data
4. Analyze the data
5. Documenting data

26. 5) Time-lapsed Reassessment
 Time lapsed reassessment, takes place after the
initial assessment to evaluate any changes in the
clients' health status.
 Assessors perform time-lapsed reassessment when
substantial periods of time have elapsed between
assessments
 (e.g., periodic outpatient clinic visits, home health
visits, health and development screenings) to
compare the client‘s current status to baseline data
previously obtained.

27. 1. Collecting Data:
Data collection is" the process of gathering information about a
client’s health
status ". It must be both systematic and continuous to prevent
the omission of
significant data and reflect a client‘s changing health status.
Types of Collected Data:
Subjective Data (Stated)
 It referred to as symptoms or covert data.
 It is the verbal statements stated to the assessor by the patient
through interview.
 It can be described or verified only by that person.

28.  It includes complete health history:
- Biographical data
- Reasons for seeking health care
- History of present health concerns
- Past health history
- Family health history
- Lifestyle and health practices profile
- Developmental level
It includes the client‘s sensations, feelings, values,
beliefs, and attitudes. Itching,
pain, and feelings of worry are examples of subjective
data.
e.g. ―I feel dizzy.‖ ―My bladder never seems empty.‖

29. Objective Data (Observed)
 It referred to as signs or overt data.
 It is evident, measurable, and verifiable observations such as
vital signs, odors, redness of a wound, hostile behavior, and
laboratory and medical imaging findings.
 It can be seen, heard, felt, or smelled, and they are obtained
by observation or physical examination.
 Objective data include:
- Physical characteristics
- Body functions
- Appearance
- Behavior
- Measurement
- Results of laboratory testing
 e.g. "Blood pressure: 90/60, Pulse 110" "patient voids 100-
150mls/void q 1-2 h.
The objective data support the subjective data: what you
observe confirms what the person is stating.

30. Sources of data:
1. Primary source: Data are directly gathered from the
client using interview and physical examination.
 The alert and oriented patient can provide
information about past illness and surgeries and
present signs, symptoms, and lifestyle.
 When the patient is unable to supply information
because of deterioration of mental status, age, or
seriousness of illness, secondary sources are used.
2. Secondary source: Data are gathered from client‘s
family members, significant others, client‘s medical
records/chart, other members of health team, and
related care literature/ journals.

31. A. Observation
 Observation is "a conscious, deliberate skill that is
developed using the five senses to gather patient and
environmental data".
 It provides the assessor with ways to check for
nonverbal expression of feelings.
B. Interview
 An interview is" A planned communication or a
conversation with purpose".
 Purposes of interview are to get or give information,
identify problems, evaluate change, teach, provide
support, or provide counseling or therapy.

32. A. Greeting client, introduce self and establishing rapport.
Use appropriate title
(Use ―Mr.‖, ―Mrs.‖, or similar titles unless the patient is a
child or adolescent).
B. Quickly review the patient's chart (to provide you with
an idea of the patient and will avoid asking repetitive
questions).
C. Setting goals for the interview.
D. Improving the environment. It should be private, quiet
and uninterrupted.
E. Taking Notes.

33. F. Inviting the Patient’s Story. Begin with open-
ended questions that allow full freedom of response,
e.g.―What brings you to the hospital?
Inquire how client is feeling; watch for signs of
discomfort such as evidence of pain or anxiety.
G. Listen actively for important symptoms, emotions,
events and relationships. Be empathetic and caring.
H. Be professional- nonjudgmental, concerned and
informed. Reactions as disapproval, impatience
(nonverbal behaviors) block communication.
I. Assure confidentiality. Assure clients that the
information you collect will be shared only with the
health care team.

34. Types of interview:
 Directive interview- Assessor directs and controls
interview, and ask mostly closed ended questions.
Client responds to questions and has limited
chances to discuss concerns.
 Nondirective interview–The role of the assessor is
to clarify, summarize, and ask mostly open-ended
questions that facilitate thought, communication
and rapport-building where the client is in control
of the purpose, subject, and pace.

35. Types of questions:
 Open-ended questions– Open-ended questions
encourage the patient to elaborate, build rapport, or
help the patient to express, clarify, or illustrate
feeling or thoughts.
 eg.―How have you been feeling lately?
 Closed-ended – used in directive interviewing, and
are questions that require a yes or no answer.
 Leading question – directs the client's answer
 e.g.―You are stressed about surgery tomorrow,
aren‘t you?‖

36. C. Physical examination
 The physical examination or physical assessment is
"A systematic data collection method to obtain the
objective data needed to complete the assessment
and detect health problem".
 To conduct the examination the assessors uses
techniques of inspection, auscultation, palpation,
and percussion.

37. 2. Validating Data:
Validation is "the act of ―double-checking‖ or verifying data to
confirm that it is accurate and factual".
3. Organizing Data:
The assessor should record data throughout the assessment
followed by formal documentation in an organized framework
using a written or computerized format that organizes the
assessment data.
Most health care agencies have developed their own structured
assessment format.
4. Analyzing Data:
Compare data against standard and identify significant cues.
Standard e.g. normal vital signs, standard weight and height,
normal laboratory/diagnostic values, normal growth and
development pattern.

38. 5. Documenting Data (Reporting & Recording):
 To complete the assessment phase, the assessor
records client data. Accurate documentation is
essential and should include all data collected about
the client‘s health status.
 Documentation is an important step of assessment
because it forms the database for the entire nursing
process and provides data for all the members of
the health care team.
 Data are recorded as facts and not as interpreted by
the assessor. e.g. the assessor records the client‘s
breakfast intake (objective) as ―coffee 240 mL, 1
egg, and 1 slice of toast.

39.  Observation is "a conscious, deliberate skill that is
developed using the five senses to gather patient and
environmental data".
 It provides the assessor with ways to check for
nonverbal expression of feelings.
 Health observation and assessment is a systematic
process to collect data about a patient. This data
provides information about the patient's condition, and
is used to inform the care which is appropriate for that
patient.
 Nurses undertake health observation and assessment
constantly, in all clinical settings. Health observation
and assessment is the first step in the nursing care cycle.

40. There are several core principles that underlie the practice
of nursing observation. The principles hold that:
 Nursing observation is multifaceted
 Observation and assessment are interrelated
 Observation is grounded in therapeutic engagement
with the person
 Nurses appreciate how inpatient environments
influence behavior
 Observations are communicated between colleagues
 There is a clear process of documentation that is timely
and descriptive

41.  During the health assessment nurses need to have
an analytical ability to observe and interpret the
nonverbal activities of the client.
 Nonverbal activities are important because they
provide a clue to understanding the feeling.
 Nurses should observe the following things during
health assessment:

42. 1. Physical Appearance
 Person's physical appearance can provide lots of
information about the client. According to Hans
Selye, a person's physical condition can be also
known through his appearance.
 For example, a person who looks sick may have
some internal disease. Inattention to dressing and
grooming suggests a person has some problem, for
that he/she does not have the energy to maintain
his grooming.
 Choice of clothing also represents the role of the
person, such as (student, worker and
professionals).

43. 2. Posture
 In the beginning, nurses need to observe the posture
and position of the client.
 An open posture exposing the large muscle group of the
client suggest his/her feeling of relaxation. It shows
he/she is comfortable with the interviewer.
 A closed position, such as crossed legs and closed arms
suggests the client is defensive and anxious he/she does
not want to share any information with the interviewer.
 Changing position during interview indicates the
comfort level with new topics.
 For example, a client was in an open posture at starting
of the interview, when the interviewer asked about the
relationship with his wife, he sat in a closed posture. It
shows client is comfortable with the 'relation' topic.

44. 3. Gesture
 Gesture shows the interest of the interviewer
towards the client.
 Nodding head, open posture, accepting client,
showing attention, or agreement is favorable
gestures.
 Whereas fidgeting of hand and picking nails shows
anxiety.
 So nurses must observe the gestures of the client to
recognize the feelings of the client.

45. 4. Facial Expression
 When we meet any person, the first thing we see is a
higher facial expression.
 The facial expression also tells many things about
that person, character, and personality. Some
physical conditions, such as pain, sadness are also
reflected through facial expressions.
5. Eye Contact
 During the interview, eye contact is very important
to show how much confident you are.
 Lack of eye contact indicates the person is shy,
withdrawn, depressed, bored, and confused.
 Casual eye contact should be there, eye contact
should not be penetrating.

46. 6. Voice
 The interviewer must aware of the tone of the voice of
the client.
 Not only spoken words give meaning, but also voice
characteristics, such as intensity, rate of speech, pitch,
and any pauses give meaning to the conversation.
 Anxious people speak louder and faster than normal.
 A soft voice may indicate the person's shyness and fear.
Even pauses also give meaning to the discussion.
7. Touch
 The meaning of touch is different according to different
cultures, past experiences, age, gender, and current
setting.
 In Western culture, it is regarded as an expression of
love. But some cultures avoid touch or it is
misinterpreted.
 Do not use touch if you do not know how another
person will take it

47.  Health assessment requires techniques, skills, and
knowledge.
 Examiner uses his/her senses, such as sight, smell,
touch, and hearing to gather data during physical
examination.
 The techniques that are required in health
assessment are inspection, palpation, percussion,
and auscultation.

48. Inspection
 Visual examination of the body is called inspection.
It is the observation with the naked eyes to
determine the structure and functions of the body.
 Observe the client while facing him/her in the bed
or chair.
 Observe the client's skin color and texture; check for
lesions and hair distribution. Look at overall body
structure.
 If the client can be out of bed, observe gait and
stance. Note all parts of the body as the examination
proceeds.
 Inspection also evaluates verbal and behavioral
responses and mental status.

49. The following principles should be kept in mind for
making accurate inspections:
 Good lighting and exposure are essential.
 Inspect each area for size, shape, color, symmetry
and proposition and find out any deviations from
normal.
 Use additional lights for examining body cavities,
e.g., oral.
 Use sense of olfaction along with visual to detect
abnormalities, e.g., bad breath indicates unhygienic
mouth conditions acidotic smell is significant of
diabetic acidosis.

50. Assessment through Inspection
One of the most important skills a nurse develops is the
ability to look at a client and determine whether they are
comfortable. A client's comfort depends on many things,
the most basic of which are that needs for hygiene,
posture, maintenance of body temperature and freedom
from pain are met. looking at a client:
Rest and Activity Needs
 Body proportion and appearance
 Range of motion in joints
 Muscular strength
 Balance
 Ability to perform activities of daily living
 Sleep pattern
 Pain

51. Nutritional, Fluid and Electrolyte Needs
 Height and usual weight
 Unusual gain or loss of weight
 Amount and types of foods eaten
 Compliance with prescribed diet
 Fluid intake and output
 Abnormal loss of body fluid
 Skin turgor and moistness of mucous membranes

52. Safety and Security
Potential risks for injury
Sensory deficits
 Ability to speak and understand English
 Need for side rails or safety devices
Hygiene and Grooming
 Ability to bathe, dress and groom self
 Amount of assistance needed
Oxygenation and Circulation Needs
 Rate and depth of breathing; breath sounds; cough or
sputum production
 Level of consciousness

53. Blood pressure
 Pulse rate and characteristics
 Peripheral pulses
Skin color and temperature
Psychosocial Needs
 Desire for spiritual assistance
 Supports
 Usual coping mechanisms
 Financial concerns
 Fears and concerns
Elimination
 Characteristics and amount of urinary output
 Characteristics and regularity of bowel movements
 Alterations in elimination
 Presence of pain, burning or other discomfort

54. As well as observing and assessing the client and their
needs, the nurse must also use the sense of sight to
assess the functioning of equipment used in client care.
Nurses assess various items of equipment to determine
whether they are functioning correctly when they are
in use, for example:
 Intravenous fluid apparatus
 Oxygen apparatus
 Urinary drainage systems
 Wound drainage systems
 Traction apparatus

55. General Inspection
 The initial act of physical examination is the
inspection of the body as a whole.
 General inspection about motor activity, body
builds outstanding anatomic malformation,
behavior, speech, nutrition, and appearance of
illness.

56. Local Inspection
 Focusing observation on a single anatomic region
yields hundreds of physical signs.
 The dermatologist relies almost entirely on the
appearance of skin lesions to make a diagnosis.
 Usage more or less confines the term inspection to
observation with the unaided eyes.
 Actually, visual, visual signs are the chief or only
rewards in the use of the ophthalmoscope, slit lamp,
gonioscope, otoscope, nasoscope, larynogoscope,
bronchoscope, gastrocope. thoracoscope,
peritoneoscope, cystoscope, anoscope, and
sigmoidoscope.
 The pathologist uses the microscope; the radiologist
inspects the fluroscopic screen and photographic films.

57.  It is the feeling of the body or a part with the hands
to note the size and positions of the organs. In
palpation, the finger pads and not the finger tips
are used. Obtain information by using the hands
and fingers to palpate.
 A light or deep palpation depends on the area being
palpated. The palmar surface of fingers and finger
pads are used to determine position of the organs,
size and consistency, fluid accumulation, pain, and
masses. The ulnar surface of the hand is used to
distinguish vibration and temperature.
 The moisture and warmth of the skin can also be
determined during palpation.

58. The following points are to be kept in mind while doing
palpation:
 The client should be relaxed and comfortable. Observe
nonverbal signs of discomfort during palpation.
 Palpation to be done with warm hands, short fingernails and
a gentle approach.
 Palpation to be done slowly, and gently
 For light palpation the hand is depressed about 1 cm (1/2
inch) and for deeper palpation it should be approximately
2.5 cm (1 inch).
 Use appropriate parts of the hands for doing various
palpations.
 The usual definition of palpation is the act of feeling by the
sense of touch. But this is too limited; when the physician
lays his hands upon the patient, he perceives physical signs
by his tactile sense, temperature sense, and his kinesthetic
sense of position and vibration.
 Palpation is widely used in the physical examination
especially in the abdomen examination.

59. Light palpation is done more frequently than deep
palpation and is always performed before deep
palpation.
 As the name implies, light palpation is superficial,
delicate, and gentle. In light palpation, the finger
pads are used to gain information on the patient's
skin surface to a depth of approximately 1
centimeter (cm) below the surface.
 Light palpation reveals information on skin texture
and moisture; overt, large, or superficial masses; and
fluid, muscle guarding, and superficial tenderness.

60. To perform light palpation:
 Keeping the fingers of your dominant hand together,
place the finger pads lightly on the skin over the area
that is to be palpated. The hand and forearm will be on a
plane parallel to the area being assessed.
 Depress the skin 1 cm in light, gentle, circular motions.
 Keeping the finger pads on the skin, let the depressed
body surface rebound to its natural position.
 If the patient is ticklish, lift the hand off the skin before
moving it to another area. Using a systematic approach
move the fingers to an adjacent area and repeat the
process.
 Continue to move the finger pads until the entire area
being examined has been palpated.
 If the patient has complained of tenderness in any area,
palpate this area last.

61. Deep Palpation
 Deep palpation can reveal information about the
position of organs and masses, as well as their size,
shape, mobility, consistency, and areas of
discomfort.
 Deep palpation uses the hands to explore the body's
internal structures to a depth of 4 to 5 cm or more.
 This technique is most often used for the abdominal
and male and female reproductive assessments.
 Variations in this technique are single-handed and
bimanual palpation.

62.  Palpation is employed on every part of the body
accessible to the examining fingers-all external
structures, all structures accessible through the body
orifices, the bones, the joints, the muscles, the
tendon sheaths, the ligaments, the superficial
arteries, thrombosed or thickened veins, superficial
nerves, salivary ducts, spermatic cord, solid
abdominal viscera, solid contents of hollow viscera,
accumulations of body fluids, pus, or blood.

63. Quality Elicited by Palpation
 The size, shape, consistency, mobility, pulsation
(expansile or transmitted) precordial cardiac thrust.
 Crepitus in bones, joints, tendon sheaths, pleura,
subcutaneous tissue.
 Tenderness in all accessible tissues.
 Thrills, over the heart and blood vessels.
 Vocal fremitus.

64.  It is the examination by tapping with the fingers on the
body to determine the condition of the internal organs
by the sounds that are produced.
 It is done by placing a finger of the left hand firmly
against a part to be examined and tapping with the
finger tips of the right hand. Produces sound waves by
using the fingers as a hammer. Place the
interphalangeal joint of the middle finger on the skin
surface of the nondominant hand. Using the tip of the
middle finger of the dominant hand, strike the placed
finger. Vibration is produced by the impact of the
fingers striking against underlying tissue. Sound or
tone of the vibration is determined by body area or
organ percussed.
 Normal lung areas produce a resonance sound; liver
sounds are dull and a flat sound is heard over muscle.

65. Characteristics of sound produced are:
 Resonance: A low pitched and loud sound heard over
the normal lung tissues.
 Hyperresonance: Very loud, very low pitch sound
longer than resonance and is of booming quality
signifies emphysema.
 Tympany: A drum-like sound heard over the air-filled
tissues, such as gastric air bubble.
 Dull: A medium-pitched sound with a medium
duration without resonance heard over solid tissues,
such as heart and liver.
 Flat: A high-pitched sound with a short duration
without resonance heard over complete solid tissues,
such as hand, thigh.
 In physical diagnosis, percussion is the method of
examination in which the surface of the body is struck to
emit sounds that vary in quality according to the
underlying tissues.

66. Types of Percussion
 There are four types of percussion techniques-
immediate, mediate, direct fist percussion, and
indirect fist percussion.
 It is important to keep in mind that the sounds
produced from percussion are generated from body
tissue up to 5 cm below, the patient should have the
opportunity to void before the surface of the skin. If
the abdomen is to be percussed.

67. Immediate Percussion
 Immediate or direct percussion is the striking of an
area of the body directly. To perform immediate
percussion:
 Spread the index or middle finger of the dominant
hand slightly apart from the rest of the fingers.
 Make a light tapping motion with the finger pad of
the index finger against the body part being
percussed.
 Note what sound is produced.

68. Mediate Percussion
Mediate percussion is also referred to as indirect percussion. This is a skill
that takes time and practice to develop and to use effectively. Most sounds
are produced using mediate percussion. Follow these steps to perform
mediate percussion:
1. Place the nondominant hand lightly on the surface to be percussed.
2. Extend the middle finger of this hand, known as the pleximeter, and press
its distal phalanx and distal interphalangeal joint firmly on the location
where percussion is to begin. The pleximeter will remain stationary while
percussion is performed in this location.
3. Spread the other fingers of the nondominant hand apart and raise them
slightly off the surface. This prevents interference and, thus, dampening of
vibrations during the actual percussion.
4. Flex the middle finger of the dominant hand, called the plexor. The
fingernail of the plexor finger should be very short to prevent undue
discomfort and injury to the nurse. The other fingers on this hand should be
fanned.

69. 5. Flex the wrist of the dominant hand and place the hand
directly over the pleximeter finger of the nondominant hand.
6. With a sharp, crisp, rapid movement from the wrist of the
dominant hand, strike the pleximeter with the plexor. At this
point, the plexor should be perpendicular to the pleximeter. The
blow to the pleximeter should be between the distal
interphalangeal joint and the fingernail. Use the finger pad
rather than the fingertip of the plexor to deliver the blow.
Concentrate on the movement to create the striking action from
the dominant wrist only.
7. As soon as the plexor strikes the pleximeter, withdraw the
plexor to avoid dampening the resulting vibrations. Do not move
the pleximeter finger.
8. Note the sound produced from the percussion.
9. Repeat the percussion process one or two times in this location
to confirm the sound.
10. Move the pleximeter to a second location, preferably the
contralateral location from where the previous percussion was
performed. Repeat the percussion process in this manner until
the entire body surface area being assessed has been percussed.

70. Direct Fist Percussion
Direct fist percussion is used to assess the presence of
tenderness and pain in internal organs, such as the
liver or the kidneys. To perform direct fist percussion:
 Explain this technique thoroughly so the patient
does not think you are hitting him/her.
 Draw the dominant hand up into a fist.
 With the ulnar aspect of the closed fist, directly hit
the area where the organ is located. The strike
should be of moderate force, and it may take some
practice to achieve the right intensity.
 The presence of pain in conjunction with direct fist
percussion indicates inflammation of that organ or
a strike of too high an intensity.

71. Definitive percussion is commonly employed to
ascertain the
 location of the lung bases,
 the width of the lung apices,
 the height of fluid in the pleural cavity
 the width of the mediastinum,
 the size of the heart,
 the outline of dense masses in the lungs the size and
shape of the liver and spleen,
 the size of a distended gallbladder and urinary
bladder,
 the level of ascitic fluid.