PHYSICAL EXAMINATION PHYSICAL EXAMINATION
DEFINITION: • A complete health assessment generally conducted from head to toe • Presents objective data • The examiner must have both technical skills and knowledge base to be effective • Involves the sense of sight, smell, touch and hearing • Involves 4 basic skills - IPPA 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 a height that prevents stooping • Provide a bedside table/ tray to hold the equipment needed for the examination Preparing Oneself
• Self-awareness • Reduce anxiety • Build confidence • Prevent the transmission of infectious agents, follow Standard Precautions Preparing Oneself
• 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 Approaching and Preparing the Client
• Establish rapport • Explain to the client that the physical assessment will follow and describe what the examination will involve • Respect the client’s desires and requests • Approach the client from the right hand side of the examination table • Prepare the client for frequent position changes 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 and gait; 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, reproductive tracts, and the rectum. Approaching and Preparing the Client POSITIONING THE CLIENT • Fowler’s Position – For evaluating the skin, head and neck; eyes, ears, nose, mouth and throat; thorax and lungs; heart and peripheral vascular; musculoskeletal; neurological. Approaching and Preparing the Client
POSITIONING THE CLIENT • Side Lying Position/ Lateral – For evaluating skin, thorax and lungs PE Guidelines PE Guidelines
• Always dress in a clean, professional manner. • Remove all bracelet, necklaces, or earrings • Be sure that your fingernails are short and your hands are warm • Be sure your hair will not fall forward and obstruct your vision or touch the patient. PE Guidelines
• Arrange for a well-lit, warm and private room. • Ensure that all the necessary equipment is ready for use and within reach. • Introduce yourself to the patient. • Clarify with the patient how he or she wishes to be addressed. PE Guidelines
• Explain what you plan to do and how long it will take. • Instruct the patient to undress; provide a gown and drape for the patient and explain how to use them. • Allow the patient to undress privately; inform the patient when you will return to start the assessment. PE Guidelines
• Have the patient void prior to the assessment. • Wash your hands in front of the patient to show your concern for cleanliness. • Observe standard precautions as indicated. • Ensure that the patient is accessible from both sides of the examination bed or table. PE Guidelines
• If a bed is used, raise the height so that you do not have to bend over to perform the assessment. • Position the patient as dictated by the body system being assessed. • Enlist the patient’s cooperation. PE Guidelines
• Warm all instruments prior to their use. • Examine the unaffected body part or side first if a patient’s complain is unilateral. • Explain to the patient why you may be spending a long time performing one particular skill. • If a patient complains of fatigue, continue the assessment later (if possible). PE Guidelines
• Avoid making rude or negative remarks. • Conduct the assessment in a systematic fashion every time. • Thank the patient when the physical assessment is concluded; inform the patient what will happen next. • Document assessment findings 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 Inspection
Guidelines: – Comfortable temperature room – Use good lighting (sunlight) – Look and observe before touching – Completely expose the body part you are inspecting while draping the rest of the client as appropriate. Inspection
Guidelines: – Note the following characteristics while inspecting the 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 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 and size, shape, degree of tenderness, as well as any swelling, 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 the touch will occur Palpation • Tools in palpation:
Fingertips / Fingerpads Dorsal Portion
Index-Thumb / Grasping Fingers Palmar/ Ulnar Surfaces Palpation Types of Palpation: Light – Superficial, delicate and gentle palpation with 1 cm depth – Reveal information on skin texture and moisture; overt, large or superficial masses; fluid, muscle guarding and superficial tenderness; for pulses and temperature Palpation Types 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 very deep organs or structures that are covered by thick muscles – Most often used for abdominal, male and female reproductive assessments – Variations in the technique include the single-handed and bimanual palpation Palpation
Types of Palpation: ***Bimanual – Use two hands placing one on each side of the body part being palpated Percussion
• Technique of striking one object against another to cause vibrations that produce sound • These sounds or vibrations enable the examiner to assess underlying structures Percussion
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 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 booming emphysema resonance
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 Auscultation
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 and bruits 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 ensure solid contact. THANK YOU!