Health assessment and physical examination latest 2021/2022.
Chapter 32 Health Assessment & Physical Examination
Techniques of Physical Assessment
➢ 4 techniques.
o 1. Inspection
o 2. Palpation
o 3. Percussion
o Auscultation.
• This technique can differs. In the abdominal assessment (start with inspection à
ausultation)
Inspection:
• Always start with inspection.
• Has to do with visual observation.
• Is hair evenly distributed, is there any lice, is there alopecia.
• Is trachea symmetrical.
o Inspection occurs when interacting with patient, watching for nonverbal expressions of
emotional and mental status.
o Physical movements and structural components can also be identified in such an informal
way.
o To inspect, carefully look, listen, and smell to distinguish normal from abnormal findings.
o To do so, must be aware of any personal visual, hearing or olfactory deficits.
➢ Use adequate lighting.
➢ Use direct lighting (penlight or lamp) to inspect body cavities.
➢ Inspect each area for size, shape, color, symmetry, position, and abnormality.
➢ Position and expose body parts as needed so all surfaces can be viewed but privacy can
be maintained.
➢ When possible, check for side-to side symmetry by comparing each area with its
match on the opposite side of the body.
➢ Validate findings with the patient.
,Health assessment and physical examination latest 2021/2022.
o While assessing a patient, recognize the nature and source of body odors.
An unusual odor often indicates an underlying pathology.
o Olfaction helps to detect abnormalies that cannot be recognizwd by any
other means.
▪ Ex.) When a patient’s breath has a sweet, fruity odor, assess
for signs of Diabetes.
Palpation:
o Palpation involves using the sense of touch to gather information.
• Through touch you make judgments about expected and unexpected findings of the skin
or underlying tissue, muscle, and bones. Ex.) Palpate the skin for temperature,
moisture, texture, turgor, tenderness, and thickness, and the abdomen for
tenderness, distention, or masses.
• Use different parts of hands to detect different characteristics.
• Hands should be warm, fingernails short and trim.
• The palmar surface of the hand and finger pads is more sensitive than the
fingertips and should be used to determine position, texture, size, consistency,
masses, fluid, and crepitus. Measure position, consistency, and turgor by
lightly grasping the body part with the fingertips.
• Palmar surface of hand and fingers is more sensitive to vibration. Measure
position, consistency, and turgor by lightly grasping the body part with the
the fingertips.
• Assess body temperature by using the dorsal surface or back of the hand.
• Display respect and concern throughout the examination.
,Health assessment and physical examination latest 2021/2022.
• Before palpating consider the patient’s condition and ability to tolerate the assessment
techniques, paying close attention to areas that are painful or tender. In addition,
always be conscious of the environment and any threats to the patient’s safety.
• Palpation proceeds slowly, gently, and deliberately.
à Palpate tender areas last.
• Two types of palpation are used for physical examination, light and deep.
• Start with light palpation; end with deep palpation.
• Light palpation is performed by placing the hand on the body part being examined; it
also involves pressing inward about 1 cm (½ inch).
• Light, superficial palpation of structures such as the abdomen gives the patient the
chance to identify areas of tenderness.
• Deep palpation is used to examine the condition of organs such as those in the
abdomen. Depress the area under examination approximately 4 cm (2 inches) using one
or both hands (bimanually).
• When using bimanual palpation, relax one hand (sensing hand) and place it lightly
over the patient’s skin. The other hand (active hand) helps apply pressure to the
sensing hand. The lower hand does not exert pressure directly and thus remains
sensitive to detect organ characteristics. For safety deep palpation should be
observed by your clinical instructor when you first attempt the procedure.
(Class Notes)
• Palpation: feeling for masses.
• Feel for size, texture, tenderness, consistency.
• Percussion: tapping
• Auscultation: listening with stethoscope.
• Diaphrgam à used for high pitch sounds. Bell à Low pitch sounds
• Listening for any adventatious sounds. ( crackles, weezing… )
• Listening to heart valves, for murmers. Listening to s1, s 2 sounds.
, Health assessment and physical examination latest 2021/2022.
Percussion:
o Involves tapping the skin with the fingertips to vibrate underlying tissues and organs.
o Tap body with fingertips to produce vibration.
o The vibration travels through body tissues, and the character of the resulting sound
reflects the density of the underlying tissue.
o The denser the tissue, the quieter the sound.
o By knowing how various densities influence sound, it is possible to locate
organs or masses, map their edges, and determine their size.
o An abnormal sound suggests a mass or substance such as air or fluid within an organ
or body cavity.
o The skill of percussion is used more often by advanced practice nurses than by nurses in
daily practice at the bedside.
o Tympani is normally heard over the stomach. Can be heard over chest.
o Tympani = A hollow drum-like sound that is produced when a gas-
containing cavity is tapped sharply. Tympani is heard if the chest contains
free air (pneumothorax) or the abdomen is distended with gas.
o Percussion over the liver produces dull sound due to solid organ.
Auscultation
o Involves listening to sounds the body makes to detect variations from normal.
• Some sounds you can hear without assistance; but the use of a stethoscope is necessary
to hear internal body sounds.
• Internal body sounds are created by blood, air, or gastric contents as they move
against the body structures.
• Learn to recognize abnormal sounds after learning normal variations. Becoming more
proficient in auscultation occurs by knowing the types of sounds each body structure
makes and the location in which the sounds are heard best.
• To auscultate internal sounds you need to hear well, have a good stethoscope, and
know how to use it properly. Nurses with hearing disorders can obtain stethoscopes
with extra sound amplification.
• The bell is best for hearing low-pitched sounds such as vascular and certain heart
sounds, and the diaphragm is best for listening to high-pitched sounds such as bowel
and lung sounds.
Chapter 32 Health Assessment & Physical Examination
Techniques of Physical Assessment
➢ 4 techniques.
o 1. Inspection
o 2. Palpation
o 3. Percussion
o Auscultation.
• This technique can differs. In the abdominal assessment (start with inspection à
ausultation)
Inspection:
• Always start with inspection.
• Has to do with visual observation.
• Is hair evenly distributed, is there any lice, is there alopecia.
• Is trachea symmetrical.
o Inspection occurs when interacting with patient, watching for nonverbal expressions of
emotional and mental status.
o Physical movements and structural components can also be identified in such an informal
way.
o To inspect, carefully look, listen, and smell to distinguish normal from abnormal findings.
o To do so, must be aware of any personal visual, hearing or olfactory deficits.
➢ Use adequate lighting.
➢ Use direct lighting (penlight or lamp) to inspect body cavities.
➢ Inspect each area for size, shape, color, symmetry, position, and abnormality.
➢ Position and expose body parts as needed so all surfaces can be viewed but privacy can
be maintained.
➢ When possible, check for side-to side symmetry by comparing each area with its
match on the opposite side of the body.
➢ Validate findings with the patient.
,Health assessment and physical examination latest 2021/2022.
o While assessing a patient, recognize the nature and source of body odors.
An unusual odor often indicates an underlying pathology.
o Olfaction helps to detect abnormalies that cannot be recognizwd by any
other means.
▪ Ex.) When a patient’s breath has a sweet, fruity odor, assess
for signs of Diabetes.
Palpation:
o Palpation involves using the sense of touch to gather information.
• Through touch you make judgments about expected and unexpected findings of the skin
or underlying tissue, muscle, and bones. Ex.) Palpate the skin for temperature,
moisture, texture, turgor, tenderness, and thickness, and the abdomen for
tenderness, distention, or masses.
• Use different parts of hands to detect different characteristics.
• Hands should be warm, fingernails short and trim.
• The palmar surface of the hand and finger pads is more sensitive than the
fingertips and should be used to determine position, texture, size, consistency,
masses, fluid, and crepitus. Measure position, consistency, and turgor by
lightly grasping the body part with the fingertips.
• Palmar surface of hand and fingers is more sensitive to vibration. Measure
position, consistency, and turgor by lightly grasping the body part with the
the fingertips.
• Assess body temperature by using the dorsal surface or back of the hand.
• Display respect and concern throughout the examination.
,Health assessment and physical examination latest 2021/2022.
• Before palpating consider the patient’s condition and ability to tolerate the assessment
techniques, paying close attention to areas that are painful or tender. In addition,
always be conscious of the environment and any threats to the patient’s safety.
• Palpation proceeds slowly, gently, and deliberately.
à Palpate tender areas last.
• Two types of palpation are used for physical examination, light and deep.
• Start with light palpation; end with deep palpation.
• Light palpation is performed by placing the hand on the body part being examined; it
also involves pressing inward about 1 cm (½ inch).
• Light, superficial palpation of structures such as the abdomen gives the patient the
chance to identify areas of tenderness.
• Deep palpation is used to examine the condition of organs such as those in the
abdomen. Depress the area under examination approximately 4 cm (2 inches) using one
or both hands (bimanually).
• When using bimanual palpation, relax one hand (sensing hand) and place it lightly
over the patient’s skin. The other hand (active hand) helps apply pressure to the
sensing hand. The lower hand does not exert pressure directly and thus remains
sensitive to detect organ characteristics. For safety deep palpation should be
observed by your clinical instructor when you first attempt the procedure.
(Class Notes)
• Palpation: feeling for masses.
• Feel for size, texture, tenderness, consistency.
• Percussion: tapping
• Auscultation: listening with stethoscope.
• Diaphrgam à used for high pitch sounds. Bell à Low pitch sounds
• Listening for any adventatious sounds. ( crackles, weezing… )
• Listening to heart valves, for murmers. Listening to s1, s 2 sounds.
, Health assessment and physical examination latest 2021/2022.
Percussion:
o Involves tapping the skin with the fingertips to vibrate underlying tissues and organs.
o Tap body with fingertips to produce vibration.
o The vibration travels through body tissues, and the character of the resulting sound
reflects the density of the underlying tissue.
o The denser the tissue, the quieter the sound.
o By knowing how various densities influence sound, it is possible to locate
organs or masses, map their edges, and determine their size.
o An abnormal sound suggests a mass or substance such as air or fluid within an organ
or body cavity.
o The skill of percussion is used more often by advanced practice nurses than by nurses in
daily practice at the bedside.
o Tympani is normally heard over the stomach. Can be heard over chest.
o Tympani = A hollow drum-like sound that is produced when a gas-
containing cavity is tapped sharply. Tympani is heard if the chest contains
free air (pneumothorax) or the abdomen is distended with gas.
o Percussion over the liver produces dull sound due to solid organ.
Auscultation
o Involves listening to sounds the body makes to detect variations from normal.
• Some sounds you can hear without assistance; but the use of a stethoscope is necessary
to hear internal body sounds.
• Internal body sounds are created by blood, air, or gastric contents as they move
against the body structures.
• Learn to recognize abnormal sounds after learning normal variations. Becoming more
proficient in auscultation occurs by knowing the types of sounds each body structure
makes and the location in which the sounds are heard best.
• To auscultate internal sounds you need to hear well, have a good stethoscope, and
know how to use it properly. Nurses with hearing disorders can obtain stethoscopes
with extra sound amplification.
• The bell is best for hearing low-pitched sounds such as vascular and certain heart
sounds, and the diaphragm is best for listening to high-pitched sounds such as bowel
and lung sounds.
