1. By Dr. Hala Yehia

2. Methods of Examination Objectives: 1-List 4 techniques for physical assessment. 2-Define inspection. 3-Determine characteristics of inspection. 4-Describe the uses of inspection during assessment.

3. Techniques of physical examination: 1-Inspection. 2-Palpation. 3-Percussion. 4-Auscultation.

4. Inspection: Is the visual examination using the sense of sight. Used naked eye and lighted instrument. In addition to olfactory and auditory cues are noted. Characteristics of inspection: Deliberate (planned). Purposeful. Systematic.

5. Visual observation for: moisture, color, and texture of body surfaces, as well as shape, position, size, color, and symmetry of the body.

6. 2- Palpation: is the examination of the body using the sense of touch. Technique: The pads of the fingers are used because their concentration of nerve endings makes them highly sensitive to tactile discrimination.

7. Palpation is used to determine: a-Texture (consistency or quality) e.g., of the hair. b-Temperature e.g., of the skin. c-Vibration e.g., of a joint. d-Position, size, consistency, and mobility of organs or masses. e-Distention e.g., of the urinary bladder. f-Pulsation. g-The presence of pain upon pressure.

8. Types of palpation: *Light (superficial). * Deep. *Light palpation: Technique: the nurse extends the dominant hand’s fingers parallel to the skin surface and presses gently while moving the hand in a circle.

9. Superficial abdominal palpation

10. *Deep palpation: is done with two hands (bimanually) or one hand. Technique: the nurse extends the dominant hand as for light palpation, then places the fingers pads of nondominant hand on the dorsal surface of the distal interphalangeal joint of the middle three fingers of the dominant hand. The top hand applies pressure while the lower hand remains relaxed to perceive the tactile sensations.

12. Deep Bimanual Abdominal Palpation

13. Palpate kidney

14. *Deep palpation: pressure can damage internal organs. It is usually not indicated in clients who have acute abdominal pain or pain that is not yet diagnosed.

15. General Guidelines for palpation:  The nurse’s hands should be clean and warm, and the fingernails short.  Areas of tenderness should be palpated last.  Deep palpation should be done after superficial palpation.

16. Factors affecting the palpation: Client’s relaxation. Gowning and/or draping the client appropriately. Positioning the client comfortably. Ensuring that their own hands are warm before beginning. During palpation the nurse should be sensitive to the client’s verbal and facial expression indicating discomfort.

17. Percussion: is the act of striking the body surface to elicit sounds that can be heard or vibration that can be felt. Types of percussion: *Direct. *Indirect.

18. Technique of direct percussion: the nurse strikes the area to be percussed directly with the pads of two, three, or four fingers or with the pad of the middle finger. Character of strikes: *Rapid. *Movement is from the wrist.

19. Technique of indirect percussion: is the striking of an object e.g., a finger held against the body area to be examined. Technique: the middle finger of the nondominant hand (pleximeter) is placed firmly on the client’s skin. Using the tip of the flexed middle finger of the other hand, called (plexor). The nurse strikes the pleximeter, usually at the distal interphalangeal joint.

20. Percuss the liver

21. Methods of Examination Character of strikes: *Movement is from the wrist. *The angle between the plexor and the pleximeter should be 90 degrees. *The blows must be firm, rapid, and short to obtain a clear sound.

22. Methods of Examination Percussion sound heard: Tympany: Gastric bubble (the greatest amount of air). Hyperresonance: booming sound emphysematous lung Resonance: Healthy lung Dullness: Liver, spleen and heart Flattness: produced by very dense tissues muscle and bone (the least amount of air)

23. Methods of Examination Auscultation: is the process of listening to sounds produced within the body. Types of a uscultation: Direct. Indirect.

24. Methods of Examination Direct auscultation: is the use of the unaided ear (to listen to a respiratory wheeze). Indirect auscultation: is the use of a stethoscope, which transmits the sounds to the nurse’s ears (as bowel sounds and blood pressure).

25. Methods of Examination Objectives: Discuss the component of general survey.

26. General Survey Component of general survey: *Observation for client’s general appearance and mental status, and measurement of vital signs, height and weight. *The client’s body build, posture, hygiene and mental status assessed while taking the history.