PHYSICAL ASSESSMENT

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HEALTH ASSESSMENT
Physical Examination

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 Purposes
 Ascertain client’s level of health &
physiological function

 Identify important factors

 Confirm alterations, disease or inability to

perform ADLs

 Identify need for additional testing /

examination

 Aid in evaluating outcome of treatment /

therapy
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Subjective and Objective Data

 Subjective Data.
History – what the patient
tells/communicates to you
 Objective Data.
Exam – what you discover through your
physical assessment

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Possible Client Position During
an Examination

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Positions for physical Examination
 Assessment positions e.g.: (Standing
position, Supine position, Sitting position,
Dorsal recumbent position, Sims position,
Prone position, Knee chest position, and
Lithotomy position)
 Each position has it's specialty for parts of
examination

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 Sitting position

 Areas Assessed: Head and neck, back,

posterior thorax and lungs, anterior
thorax , breasts, axillae, heart, vital
signs, and upper extremities
 Limitations: Physically weakened client
may be unable to sit

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Supine position
 Most normally relaxed position
 Areas Assessed: Head and neck
anterior thorax and lungs, breasts,
axillae, heart, abdomen, extremities,
pulses
 Limitations: Not use for client SOB,
you may need to raise head of bed

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Dorsal position
 Areas Assessed: Head and neck, anterior
thorax and lungs, breasts, axillae, heart.

 Limitations: Not used for abdominal

assessment because it promotes
contracture of abdominal muscles

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 . Lithotomy Position
 Areas Assessed: Female genitalia and genital
tract.
 * Limitations:
 This position is embarrassing &
uncomfortable, so examiner minimizes time
that client spends in it.
 Client is kept well draped.
 This position not used for Client with
severe arthritis or other joint deformity

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 Sims’ position
 Areas Assessed: Rectum and vagina.
 * Limitations: Joint deformities may
prevent client’s ability to Bend hip
and knee

Prone position:
 * Areas Assessed: Musculoskeletal
system.
 * Limitations: don’t use this position
for client with respiratory difficulties

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Knee-chest position

Areas Assessed: Rectum.

Limitations: This position is embarrassing and
uncomfortable. Don’t use this position for
Clients with arthritis or other joint
deformities.
 When palpation assess for Crepitus (crackling
sensation & noise caused by rubbing of bone
fragments).
 * If a joint appears swollen and inflamed,
detect warmth in the tissues.

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Equipment Preparation For a
Health Assessment

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Indications for the Physical Exam

 Routine screening
 Eligibility prerequisite for health
insurance, military service, job, sports,
school
 Admission to a hospital or long term care
facility

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STEPS OF ASSESSMENT
 Think
 Organize
Don’t forget…Nutrition / Height & Weight
 Environment:
 Accommodate special needs (cultural
sensitivity)
 Equipment - clean surface & clean equipment
Room - quiet, warm & well lit
 Maintain privacy
 Observe & Listen
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DON’T FORGET……

 REVIEWING GENERAL
INFORMATION
 INTRODUCTION TO CLIENT
 OBTAINING THE HEALTH
HISTORY
 PAIN ASSESSMENT
 THIS IS KEY TO HOLISTIC
APPROACH

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Five Assessment Techniques During
A Physical Examination

 Inspection

 Palpation

 Percussion

 Auscultation

 Olfaction
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Inspection

 Use vision& smell

 Always first
 Look for symmetry
 Use good lighting
 Use good exposure

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Principles of Accurate Inspection
 Good lightening either day light or
artificial light is suitable.
 Expose body parts being observed only.
 look before touching.
 warm room for examination of the
client “not cold not hot".
 Observe for color, size, location,
texture, symmetry, odors, and sounds.
 Compare each area inspected with the
opposite side of body if possible.
 Use pen light to inspect body cavities.

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Palpation
 Touch & feel with hands to determine:
 Texture – use fingertips
 Temperature – use back of hand
 Moisture
 Organ location and size
 Slow and systematic
 Light to deep
 Light palpation (tenderness)
 Deep palpation (abdominal organs/masses)

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Light palpation

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Deep palpation

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Principles for Accurate Palpation
 Examiner finger nails should be short.
 Use sensitive part your hand.
 Light Palpation precedes deep palpation.
 Start with light then deep palpation
 Tender area are palpated last
 Client must relax during palpation.
 Tell client to take slow deep breath to
enhance muscle relaxation.
 Examine condition of the abdominal organs
 Depressed areas must be approximately
“2cm”
 Assess turger of skin measured by lightly
grasping the body part with finger tips.

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Percussion

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Percussion
 Tapping of body part to assess tenderness,
Size, location, density
 Direct: with one or two fingers e.g.
Sinuses
 Indirect: middle finger of left hand
against the body surface with palm and
fingers remaining off the skin,
 and the tip of the middle finger of the right
hand strikes the base of the distal joint.
 Use a quick & sharp stroke
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Five Percussion Sounds Produced in
Different Body Regions

 Resonant – normal lung

 Hyper resonant – infant lung, emphysema
 Tympany – air filled (stomach)
 Dull – organ (liver, spleen)
 Flat – no air (thigh muscle, bone, tumor)

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Auscultation

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 Auscultation
 Listening to body sounds
 Movement of air (lungs)
 Blood flow (heart)
 Fluid & gas movement
(bowels)
 Remember the sound
changes in the abdomen…

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 HOW TO BEGIN…
 Positions for physical exam
 Using a stethoscope:
 longer the tube – more sound has to travel
 Hold diaphragm firmly against client’s skin
(NOT THROUGH CLOTHING!!)
 If using bell – less pressure
 Warm in your hands first!
 Listen / Concentrate on the sounds

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Olfaction
Another skill that used during assessment.
Certain alteration in body function creates
characteristic body odors.
Smelling can detect abnormalities that
unrecognized by other means.

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Assessment of Characteristic Odors
 Alcohol odor from oral mouth ingestion of alcohol.
 Ammonia from urine means urinary tract infection.
 Bad odor from skin, (e.g. under arms and beneath
breasts) means poor hygiene, excess perspiration
(bromidrosis)(foul smelling perspiration).
 Feces odor from wound site means wound abscess, but
this odor from vomitus this means bowel obstruction,
and if the odor from rectal area this means fecal
incontinence.
 Foul smelling stool in infant means mal absorption
syndrome.

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Assessment of Characteristic
Odors…cont
 Halitosis from oral cavity means poor
dental hygiene.
 Sweat, fruity ketenes from mouth DKA
 Musty odor from organ with cast part
means infection inside cast.
 Fetid odor from tracheotomy or mucous
secretions means infection

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Basic Guidelines for Physical Assessment
 Obtain a nursing history.
 Maintain Privacy.
 Explain the procedure and purpose of each
examined part of the client.
 Follow a planned order of examination for
each body system.

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Basic Guidelines for Physical Assessment cont..

 Inspect, palpate, percuss, and then auscultate,

except in the abdomen auscultate then percuss
to avoid alteration in the bowel sounds
 Compare symmetrical sides of the body and
organs.
 Assess both structure and function of each
body part and organ e.g. (the appearance and
condition of the ear as well as its hearing
function)

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Basic Guidelines for Physical Assessment cont..
 If there is abnormality assess for further data.
e.g. radiation of pain, effect on eating? bowels?
ADLs?
 Assess self physical assessment (e.g. exam of
the breast, testicular exam, foot care for the
diabetic)
 Allow time for client questions
 “Remember: the most important guideline for
adequate physical assessment is, continuous
practice of physical assessment skills”

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Variation in Physical Assessment of the
Pediatric Client
 Sequence of physical assessment depends on
the development level of the client.
 Establishment of rapport with the child and
significant others is the most essential step in
physical assessment data.
 Reduce fearing of child prior to beginning
the examination.
 You may require physical restraint of the
client with help of another adult.
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Variation in Physical Assessment of the
Pediatric Client…cont
 Assistance from the child’s significant caregiver
may facilitate examination.
 Assessment approach of the child based on
child's response.
 Uncooperative attitude toward the examiner is a
normal finding in children from birth to early
adolescence.

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 Variations for Physical Assessment of the
Geriatric Client
 Remember normal variation related to aging.
 Divide the physical assessment into parts in
order to avoid fatigue.
 Provide room with comfortable temperature.
 Allow sufficient time for client to respond to
directions.
 If possible assess the elderly clients in a
setting position.
 Give him/her fulltime to understand you.

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THANK YOU

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