This document provides guidance on techniques for performing a physical examination. It outlines the main techniques used which are inspection, palpation, percussion, auscultation, and sometimes olfaction. It then describes each technique in detail, how to perform it, and what areas of the body each is used to examine. The goal is to gather clinical data about the patient's physical health and identify any abnormalities.

1. THE TECHNIQUES OF
PHYSICAL EXAMINATION
PREPARED BY:
USHA RANI KANDULA,
ASSISTANT PROFESSOR,
DEPARTMENT OF ADULT HEALTH NURSING,
ARSI UNIVERSITY,ASELLA,ETHIOPIA,
EAST AFRICA.

2. TECHNIQUES OF PHYSICAL EXAMINATION
The skills used in physical examination include
inspection,
palpation,
percussion,
auscultation, and sometimes
olfaction.

3. will use these skills in that order, with one
exception:
When performing an abdominal assessment,
perform auscultation before percussion and
palpation to avoid disturbing the abdominal
sounds.

4. INSPECTION
Inspection is the use of sight to gather data.
will begin to use inspection the moment you
meet the client and continue as you observe the
person’s gait, personal hygiene, and behavior
during the general survey.

5. You will also use inspection and such
abnormalities as-
Edema,
Masses, or
 Areas of tenderness.

6. -As we begin and move through the assessment
of each body system, always inform the client that
you are about to touch him, and use a gentle
approach.
-Be certain your hands are warm.

7. PALPATION
Begin with light pressure to detect surface
characteristics.

9. -Then move to deep palpation to assess the
underlying structures.
-Examine last any areas of discomfort or
sensitivity.

10. Following is a list of the most common palpation
techniques, using different parts of the hand.

11. FINGERTIPS:
Use for fine tactile discrimination, including
assessment of skin texture,
swelling,
and specific locations of pulsations and
masses.

12. Dorsum of hand: Use for temperature
determination.
■ Palmar surface of hand: Use for locating
general area of pulsations.

13. Grasping with fingers and thumb:
Use to detect the position, shape, and
consistency of a mass.

14. PERCUSSION
Percussion is tapping your fingers on the skin
using short strokes.

15. INDIRECT PERCUSSION

16. -Tapping (percussing) produces vibrations, and
the resulting sound allows you to determine
location,
size, and
 density of underlying structures.

17. Percussion is especially useful when
assessing the abdomen and lungs.
Percussion takes practice.

18. DIRECT AUSCULTATION
-Direct auscultation is listening without using an
instrument.

19. INDIRECT AUSCULTATION
-If use of a stethoscope, you have already
performed direct auscultation.

20. INDIRECT AUSCULTATION
-Indirect auscultation is listening with the help
of a stethoscope.
-The stethoscope has two end pieces, the
diaphragm and the bell.

21. -Use the diaphragm to listen to high-pitched
sounds that normally occur in the heart, lungs,
and abdomen.

22. -Press the diaphragm hard enough to produce
an obvious ring on the patient’s skin.

23. -Use the bell to hear low-pitched sounds, such as
extra heart sounds (murmurs) or turbulent blood
flow, known as bruits.

24. -Apply the bell lightly with just enough pressure
to produce an air seal with its entire surrounding.

25. OLFACTION
-To improve your skill in indirect auscultation,
Olfaction is the use of the sense of smell to gather
data.

26. -Finally, unless this is an initial assessment,
review the nursing plan of care and keep it in
mind as you examine the patient.

27. -The assessment data may lead to
modification or updating of the care plan.

28. -If the client is unable to sit, assist him to a
position on his back with the head of the bed
elevated.

29. -A patient with a cervical spine problem
would need a neck roll when lying supine.

30. GENERAL EXAMINATION

31. DRESS, GROOMING, AND HYGIENE
-A client’s ability to dress and perform personal
hygiene is affected by physical and emotional
well-being.

32. -An unkempt appearance may reflect chronic
pain, fatigue, depression, or low self-esteem.

33. -Poor hygiene may indicate a self-care deficit
of physical or mental origin, or lack of easily
accessible bathroom facilities.

34. MENTAL STATUS
-Mental state includes level of consciousness and
capacity to interact.

35. -If the client has an altered mental status, ask a
family member about the onset of the change.

36. -Lethargy may be due to medications;
depression; or a neurological, thyroid, liver,
kidney, or cardiovascular disorder.

37. -Confusion and irritability may indicate
hypoxia or medication side effects.

38. -Inability to provide a health history or to recall
information may indicate a neurological disorder.

39. VITAL SIGNS
-You should assess vital signs as a part
of the general survey and with
subsequent assessments.

40. HEIGHT AND WEIGHT
-Height and weight provide valuable
information about your client’s growth and
development, nutritional status, overall general
health, and risk for various diseases such as
diabetes and heart disease.

41. -These data are important for proper
dosing of medication.

42. -For adults who can stand, measure height
and weight using a platform scale with a
sliding ruler.

43. -For growth charts for males and females from
birth to 20 years of age, Body mass index (BMI)
evaluates the relationship between height and
weight.

44. -You can calculate the BMI for adults
using a BMI calculator or table.

45. THANKING YOU