PHYSICAL EXAMINATION

DEFINITION:

• A complete health assessment generallyconducted from head to toe

• Presents objective data

• The examiner must have both technical skillsand knowledge base to be effective

• Involves the sense of sight, smell, touch andhearing

• Involves 4 basic skills - IPPA

PHYSICAL EXAMINATION

Preparation Guidelines

Preparing the Physical Setting

• Ensure a comfortable, warm temperature

• Provide an area free from interruptions

• Provide a quiet area free of distractions

• Provide an area with adequate lighting

• Provide a firm examination table or bed at aheight that prevents stooping

• Provide a bedside table/ tray to hold theequipment needed for the examination

Preparing Oneself

• Self-awareness

• Reduce anxiety

• Build confidence

• Prevent the transmission of infectious agents, follow Standard Precautions

• Standard precautions

– Hand Hygiene

– Gloves

– Mask, Eye Protection, Face Shield

– Gown

– Patient Care Equipment

– Environmental Control

– Linen

– Occupational Health and Blood-Borne Pathogens

– Patient Placement

Preparing Oneself

Approaching and Preparing the Client

• Establish rapport

• Explain to the client that the physicalassessment will follow and describe what theexamination will involve

• Respect the client’s desires and requests

• Approach the client from the right hand sideof the examination table

• Prepare the client for frequent positionchanges

Approaching and Preparing the Client

POSITIONING THE CLIENT

• Sitting Position

– For evaluating the skin, head and neck;eyes, ears, nose, mouth and throat;back; posterior thorax and lungs;anterior thorax and lungs; breast;axillae; heart; peripheral vasculature;musculoskeletal; neurological.

Approaching and Preparing the Client

POSITIONING THE CLIENT

• Supine Position / Horizontal Recumbent

– For evaluating the head, neck, chest, breasts,axillae, abdomen, heart, lungs and all extremities.

Approaching and Preparing the Client

POSITIONING THE CLIENT

• Dorsal Recumbent Position

– For evaluating the head, neck, chest, axillae, lungs,heart, extremities, breasts and peripheral pulses;female genitalia.

Approaching and Preparing the Client

POSITIONING THE CLIENT

• Sims’ Position

– For rectal and vaginal area assessment.

Approaching and Preparing the Client

POSITIONING THE CLIENT

• Standing Position

– For assessment of posture, balance andgait; and male genitalia.

Approaching and Preparing the Client

POSITIONING THE CLIENT

• Prone Position

– For hip joint and back assessment.

Approaching and Preparing the Client

POSITIONING THE CLIENT

• Knee-Chest Position

– For examining rectum and prostate.

Approaching and Preparing the Client

POSITIONING THE CLIENT

• Lithotomy Position

– For examining female genitalia, reproductivetracts, and the rectum.

Approaching and Preparing the ClientPOSITIONING THE CLIENT

• Fowler’s Position

– For evaluating the skin, head and neck; eyes, ears,nose, mouth and throat; thorax and lungs; heartand peripheral vascular; musculoskeletal;neurological.

Approaching and Preparing the Client

POSITIONING THE CLIENT

• Side Lying Position/ Lateral

– For evaluating skin, thorax and lungs

PE Guidelines

• Always dress in a clean, professional manner.

• Remove all bracelet, necklaces, or earrings

• Be sure that your fingernails are short andyour hands are warm

• Be sure your hair will not fall forward andobstruct your vision or touch the patient.

PE Guidelines

• Arrange for a well-lit, warm and private room.

• Ensure that all the necessary equipment isready for use and within reach.

• Introduce yourself to the patient.

• Clarify with the patient how he or she wishesto be addressed.

PE Guidelines

• Explain what you plan to do and how long itwill take.

• Instruct the patient to undress; provide agown and drape for the patient and explainhow to use them.

• Allow the patient to undress privately; informthe patient when you will return to start theassessment.

PE Guidelines

• Have the patient void prior to the assessment.

• Wash your hands in front of the patient toshow your concern for cleanliness.

• Observe standard precautions as indicated.

• Ensure that the patient is accessible from bothsides of the examination bed or table.

PE Guidelines

• If a bed is used, raise the height so that you donot have to bend over to perform theassessment.

• Position the patient as dictated by the bodysystem being assessed.

• Enlist the patient’s cooperation.

PE Guidelines

• Warm all instruments prior to their use.

• Examine the unaffected body part or side firstif a patient’s complain is unilateral.

• Explain to the patient why you may bespending a long time performing oneparticular skill.

• If a patient complains of fatigue, continue theassessment later (if possible).

PE Guidelines

• Avoid making rude or negative remarks.

• Conduct the assessment in a systematicfashion every time.

• Thank the patient when the physicalassessment is concluded; inform the patientwhat will happen next.

• Document assessment findings

PE Guidelines

Techniques in Physical Assessment

Techniques in Physical Assessment

1. Inspection

2. Palpation

3. Percussion

4. Auscultation

Inspection

• concentrated watching

• involves using the senses of vision, smell and hearing

• ongoing process

Guidelines:

– Comfortable temperature room

– Use good lighting (sunlight)

– Look and observe before touching

– Completely expose the body part you areinspecting while draping the rest of the client asappropriate.

Inspection

Guidelines:

– Note the following characteristics while inspectingthe client:

• color, pattern, size, location, consistency, symmetry,movement, behaviors, odors and sound

• body features & symmetry, general appearance,nutritional state, hair distribution, color & shape,posture & gait, manner of speaking, gross deviation

– Compare the appearance of symmetric body parts

Inspection

Palpation

• the act of touching a patient in a therapeutic manner to elicit specific information.

Palpation

• It applies your sense of touch to assess these factors:

– texture, temperature, moisture, mobility,consistency, strength of pulses, organ location andsize, shape, degree of tenderness, as well as anyswelling, vibration, rigidity or spasticity,crepitation, presence of lumps or masses.

Palpation

• Prior to palpating a patient, some basic principles need to be observed:

– have short fingernails

– Warm hands prior to placing them on the patient

– Encourage the patient to continue to breathe

– If pain is experienced, discontinue immediately

– Inform the patient where, when and how thetouch will occur

Dorsal Portion

Palmar/ Ulnar Surfaces

Fingertips / Fingerpads

Index-Thumb / Grasping Fingers

Palpation

• Tools in palpation:

PalpationPalpationTypes of Palpation:

Light

– Superficial, delicate and gentle palpation with 1 cm depth

– Reveal information on skin texture and moisture; overt, largeor superficial masses; fluid, muscle guarding and superficialtenderness; for pulses and temperature

PalpationPalpationTypes of Palpation:

Moderate

– Depress the skin surface 1 to 2 cm and use a circular

motion to feel for easily palpable organs and masses

Deep

– Depression between 2.5 to 5 cm allowing feeling verydeep organs or structures that are covered by thickmuscles

– Most often used for abdominal, male and femalereproductive assessments

– Variations in the technique include the single-handedand bimanual palpation

PalpationPalpation

Types of Palpation:

***Bimanual

– Use two hands placing one on each side of the body part

being palpated

Percussion

• Technique of striking one object againstanother to cause vibrations that producesound

• These sounds or vibrations enable theexaminer to assess underlying structures

Uses:

– Eliciting pain

– Determining location, size and shape

– Determining density

– Determining abnormal masses

– Eliciting reflexes

Percussion

How to perform percussion:

– The Stationary Hand / Pleximeter

– The Striking Hand / Plexor

Percussion

Types of percussion

1. Direct or Immediate

2. Indirect or Mediate

3. Blunt

Percussion

Production of Sound

1. Amplitude (intensity) – loudness or softness

2. Pitch (frequency) – no. of vibrations/second

3. Quality (timbre) – distinctive overtones

4. Duration – length of time the note lingers

Percussion

Characteristics of Percussion Sound

Sound Intensity Pitch Duration Quality Location

tympany loud high mod. drum-like stomach

resonance mod. to loud low long hollow normal lung

hyperresonance very loud very low longer than

resonance

booming emphysema

dullness soft to mod. high mod. thudlike liver

flatness soft high short flat muscle

Auscultation

- the act of active listening to body organs- Includes listening to both voluntary and

involuntary sounds

Types of Auscultation

1. Direct or Immediate

2. Indirect or Mediate

Characteristics of sound:

• Frequency / pitch

• Loudness / intensity (amplitude)

• Quality

• Duration

Auscultation

Guidelines during auscultation:

o Eliminate distracting or competing noises

o Expose the body part to auscultate

o Use the diaphragm of the stethoscope to listen for

high-pitched sound such as normal heart sounds,breath sounds & bowel sounds

o Use the bell of the stethoscope to listen for low

pitched sounds such as abnormal heart sounds andbruits

Auscultation

Guidelines when using stethoscope:

1. Tubing should not be longer than 12 – 15 inches.

2. Insert earpieces pointing toward you’re your nose.

3. Keep tubing free of contact with any surface.

4. Create a quiet environment before beginning auscultation.

5. Warm end piece by rubbing in palm.

6. Hold stethoscope firmly an exert enough pressure to ensuresolid contact.

Auscultation

THANK YOU!