1. Islamic University of Gaza Faculty of Nursing
Chapter 4
PHYSICAL ASSESSMENT
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2. HEALTH ASSESSMENT Physical Examination

3. Objectives Five assessment techniques during a physical examination
Differences between subjective and objective data
Immediate and mediate percussion technique
Five percussion sounds produced in different body regions
Uses of stethoscope
Equipment preparation for a health assessment

4. 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

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

6. Possible Client Position During an Examination

8. Equipment Preparation For a Physical Assessment

10. 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

11. 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

12. Don’t Forget…// Reviewing General Information. Introduction To Client.
Obtaining The Health History.
Pain Assessment.
This is Key to Holistic Approach.

13. Five Assessment Techniques During A Physical Examination
Inspection
Palpation
Percussion
Auscultation
Olfaction

15. Inspection Use vision& smell Always first Look for symmetry
Use good lighting
Use good exposure

17. 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.

18. 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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19. Light palpation

20. Deep palpation

21. Principles for Accurate Palpation
Examiner finger nails should be short.
Use sensitive part of 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.

22. Percussion

23. 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

24. 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)

25. Auscultation

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

27. HOW TO BEGIN… Positions for physical examination. 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

28. Olfaction
Another skill that used during assessment, certain alteration is body function create characteristic body odors, smelling can detect abnormalities that unrecognized by other means.

29. Assessment of Characteristic Odors
Alcohol odor from oral mouth → ingestion of alcohol.
Ammonia from urine → urinary tract infection.
Bad odor from skin, (e.g. under arms and beneath breasts) means poor hygiene, excess perspiration (bromhidrosis). 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.

30. Assessment of Characteristic Odors…cont
Halitosisرائحة كريهة from oral cavity means poor dental hygiene.
Sweat, fruity ketenes from mouth DKA
Mustyعفن odor from organ with cast part means infection inside cast.
Fetidنتن odor from tracheotomy or mucous secretions means infection

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

32. 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)

33. 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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34. Variation in Physical Assessment of the Pediatric Client
Sequence of physical assessment depends on the development level of the client
Establishment of report with the child and significant other 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.

35. 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.

36. 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 fulltime to understand you.

37. THANK YOU