Physical Examination Techniques Chapter 8 Physical Examination Techniques

Competencies Describe how to maintain Standard Precautions and Transmission-Based Precautions during the physical examination. Establish an environment suitable for conducting a physical examination. (continues)

Competencies Describe how to perform inspection, palpation, percussion, and auscultation, and identify which areas of the body are assessed with each technique. Demonstrate inspection, palpation, percussion, and auscultation in the clinical setting.

Aspects of Physical Examination Purposes of physical examination Screening of general well-being Validation of complaints that caused patient to seek health care Monitoring of current health problems Formulation of diagnoses and treatments

Role of the Nurse Comprehensive physical examination vs. focused physical examination Utilize Standard Precautions and Transmission-Based Precautions during examination (continues)

Role of the Nurse Standard Precautions Most important infection control practice is hand washing CDC guidelines for hand hygiene Utilize personal protective equipment (continues)

Role of the Nurse Transmission-Based Precautions Contact precautions Droplet precautions Airborne precautions (continues)

Role of the Nurse Legal issues Accurate, complete documentation Ensure that patient is properly informed of examination procedures

Examination Techniques Inspection (I) Palpation (P) Percussion (P) Auscultation (A) Usually follow order IPPA, except for the abdomen (IAPP)

Inspection Use of one’s senses of vision and smell to consciously observe patient Careful observation Tangential lighting if necessary

Palpation Act of touching patient in a therapeutic manner to elicit information Tips Warm hands Short nails Inform patient of when, where, and how the touch will occur (continues)

Palpation Light palpation Superficial, delicate, gentle Use finger pads Depress 1 cm below surface Use to examine skin texture, moisture, masses, fluid, muscle guarding, and tenderness (continues)

Palpation Deep palpation Use to determine position of organs, masses, and their size, shape, mobility, and consistency Use hands Depress 4 to 5 cm below skin surface Use to examine abdominal and reproductive structures

Percussion Striking one object against another to cause vibrations that produce sound Any part of the body can be percussed (continues)

Percussion Most commonly used for abdomen and thorax Analyze sounds by intensity, duration, pitch

Quality of Sounds Flatness Dullness Resonance Hyperresonance Tympany

Percussion Techniques Direct or immediate Indirect or mediate Direct fist Indirect fist

Auscultation Act of actively listening to organs to hear voluntary and involuntary sounds Quiet environment is needed Analyze sounds in relation to intensity, pitch, duration, quality, and location

Types of Auscultation Direct or immediate Indirect or mediate Listening with the unaided ear Indirect or mediate Listening with an amplification or mechanical device Examples: acoustic stethoscope, Doppler stethoscope

Commonly Used Equipment Pen and paper Tape measure Clean gloves Penlight Scale Thermometer Sphygmomanometer (continues)

Commonly Used Equipment Stethoscope Otoscope Ophthalmoscope Visual acuity charts Tuning fork Reflex hammer Lubricant

Preparing for a Physical Examination Clean, professional appearance Short fingernails Warm hands and equipment Ensure hair and jewelry will not interfere with the exam (continues)

Preparing for a Physical Examination Well-lit, warm, private, quiet room Introduce self Explain exam Dress patient in gown, drape, and underpants (continues)

Preparing for a Physical Examination Have patient void before examination Wash hands Adhere to Standard and Transmission-Based Precautions (continues)

Preparing for a Physical Examination Position patient as needed Create a therapeutic environment Explain examination Be cognizant of verbal and nonverbal communication Avoid making negative or crude remarks Avoid offensive facial expressions (continues)

Preparing for a Physical Examination Proceed using a head-to-toe or other systematic approach Thoroughly document findings Thank patient when exam is concluded

Positioning for Physical Exam Fowler’s High Fowler’s or semi-Fowler’s Use to assess skin, head, neck, eyes, ears, nose, mouth, throat, thorax, lungs, heart, peripheral vasculature, neurological system (continues)

Positioning for Physical Exam Horizontal recumbent Use to assess breasts, heart, peripheral vasculature, abdomen, musculoskeletal system Dorsal recumbent Use to assess female genitalia, anterior thorax and lungs, breasts, axillae, heart and peripheral vasculature, abdomen, musculoskeletal (continues)

Positioning for Physical Exam Lithotomy Use to assess female genitalia and rectum Knee-chest Use to assess rectum and prostate (continues)

Positioning for Physical Exam Sims’ Use to assess rectum and female genitalia Prone Use to assess skin, posterior thorax and lungs, hips Side-lying Use to assess skin, thorax and lungs, bedridden patients

Golden Rules for Physical Examination Stand on the right side of patient to establish a dominant side for examination Use a head-to-toe approach Compare right to left sides of the body for symmetry (continues)

Golden Rules for Physical Examination Proceed from least invasive to most invasive Use a systematic approach