**ASSESSMENT TECHNIQUE& GENERAL

SURVEY
Prepared by: Jeffrey Esteron

INTRODUCTION
P/E requires that examiner develop technical
skills & a knowledge base.
we see only what we know. to recognize a
significant finding, you need to know what
to look for. You will use your senses to
gather data during P/E, these skills are:
inspection, palpation, percussion&
auscultation in this order.

start with v/s measurement, wash your hands

INSPECTION:
is concentrated watching, first as a whole & then of each body system. It
always comes first. Train your self not to rush .Compare the right & left
sides of the body, requires good lighting, adequate exposure &
occasional use of certain instruments.

INSPECTION

PALPATION:
applies your sense of touch to assess these factors: texture, temperature,
moisture, organ location& size, as well as any swelling, vibration or
pulsation, presence of lumps or masses & presence of tenderness or
pain.

PALPATION

DIFFERENT PARTS OF THE HANDS

BEST SUITED FOR ASSESSING
DIFFERENT FACTORS:
1-

Fingertips: for fine tactile discrimination, as of skin texture, swelling,

pulsation, lumps.

2-

A grasping action of the fingers & thumb- to detect the position of an

organ or mass

3-

The dorsa(backs) of hands & fingers- best for determining temperature

4-

Base of fingers- best for vibration.

Technique should be slow & systematic. use a calm, gentle approach. warm
your hands by kneading them together or holding them under warm water.
Identify any tender areas & palpate them last.

- Start with
1- light palpation to detect surface characteristics & to accustom the person
to being touched.
2- Then deeper palpation, intermittent pressure is better than one long
continuous palpation.
3- Bimanual palpation requires the use of both of your hands to envelop
certain body parts or organs- such as kidneys.

PERCUSSION:

its tapping the

persons skin with
short, sharp strokes to
assess underlying
structures. The strokes
gives a palpable
vibration & density of
the underlying organ.
Percussion has the
following uses:
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PERCUSSION:CONT

1- mapping out the location & size of organ

2- signaling the density(air, fluid or solid) of a structure by a characteristic

note.
3- detecting an abnormal mass superficial(5 cm deep)
4- eliciting pain if the underlying structure is inflamed
5- Eliciting a deep tendon reflex using the percussion hammer.

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THE STATIONARY HAND:

Hyperextend the middle finger & place its

distal portion firmly against the persons
skin. Lift the rest of the stationary hand
up off the persons skin, the resting hand
will dampen off the produced vibrations.

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THE STRIKING HAND:

use the middle finger of your dominant

hand as the striking finger, with your
upper arm & shoulder steady. Action is
all in the wrist, spread your fingers wish
your wrist & bounce your middle finger
off the stationary one. Aim for behind the
nail bed or at the distal interpharyngeal
joint, its tip not the finger pad, makes
contact, percuss 2 times, the force of the
blow determines the loudness of the
note, the thickness of the persons body
wall will be a factor.
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PRODUCTION OF THE SOUND:

- all sounds results from vibration of some structure, percussion notes is
differentiated by (component of percussion):

amplitude(or intensity, aloud or soft sound)

pitch(or frequency, no of vibrations/sec)
quality(subjective difference due to a sounds distinctive overtones)
duration(length of time the note lingers).

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AUSCULTATION:

- its listening to sounds

produced by the body as
heart& lung, through a
stethoscope , doesnt
magnify sound but does
block out extraneous room
sounds. The fit & quality of
the stethoscope are
important.

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STETHOSCOPE
a stethoscope with 2 end
pieces a diaphragm & bell .
Diaphragm its flat edge
best for high-pitched
sounds-breath, bowel&
normal heart, hold the
diaphragm firmly against
skin. The bell best for soft,
low-pitched sounds as
murmurs hold it lightly
against skin.
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YOU MUST ELIMINATE ANY

CONFUSING ARTIFACT:
1. Any extra room noise
2. Warm room (shivering draw out the
involuntary muscle contractions).
3. Warm stethoscope by rubbing it in your
palm
4. Friction on the end piece from males
hairy chest causes a crackling sound that
mimics abnormal breath so wet the hair
before auscultation
5. Never listen through a gown
6. Avoid your own artifact as breathing on
the tubing or the thumb from bumping the

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SETTING:

- Warm comfortable, quite, private & well lit, natural lighting.

- Position the examination table so both sides of person are easily
accessible, a suitable height.

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EQUIPMENT:

1- scale with height

attachment
2- skin fold caliper
3- sphygmomanometer
4- stethoscope with bell
& diaphragm
5- thermometer
6- penlight
7- otoscope /
ophthalmoscope
8- turning fork

9-

nasal speculum

10-tongue depressor
11-vision screen
12-tape measurement&
ruler
13-reflex hammer
14-cotton ball

15-vaginal speculum
16- gloves
17- Lubricant
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GENERAL SURVEY:
Its a study of the whole person, covering the health state & any physical
characteristic.

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 PHYSICAL APPEARANCE:
- age( does he appear his stated age)
- sex(sexual development appropriate for gender& age)
- level of consciousness(alert, oriented)
- skin color( even, varying with genetic background, no lesions)
- facial features(symmetric with movement)

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BODY STRUCTURE:
stature(height appropriate with age)
nutrition(weight appropriate with height
&body build)
symmetry (body parts look equal
bilaterally)
posture(stands comfortably as appropriate
for age
Position (sits comfortably in a chair or in
the bed, arm relaxed at sides.
Body build, contour(arm span equal
height)

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MOBILITY:

Gait(base is wide as the shoulder width, walk smooth& well balanced

Range of motion: full mobility for each joint, with accurate smooth
coordinated no involuntary movement.

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BEHAVIOR:

Facial expression: maintain eye contact,

expressions appropriate to situation.
Mood & affect: comfortable &cooperative
with the examiner
Speech: articulation is clear &
understandable, fluently, appropriate to
culture& education
Dress & personal hygiene: appropriate to
climate, fits the body, appropriate to
culture& age. Clean, hair brushed&
groomed.
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Thank you

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