1. Physical Examination Techniques
Chapter 8
Physical Examination Techniques

2. Competencies
Describe how to maintain Standard Precautions and Transmission-Based Precautions during the physical examination.
Establish an environment suitable for conducting a physical examination.
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3. 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.

4. 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

5. Role of the Nurse
Comprehensive physical examination vs. focused physical examination
Utilize Standard Precautions and Transmission-Based Precautions during examination
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6. Role of the Nurse Standard Precautions
Most important infection control practice is hand washing
CDC guidelines for hand hygiene
Utilize personal protective equipment
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7. Role of the Nurse Transmission-Based Precautions Contact precautions
Droplet precautions
Airborne precautions
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8. Role of the Nurse Legal issues Accurate, complete documentation
Ensure that patient is properly informed of examination procedures

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

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

11. 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
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12. 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
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13. 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

14. Percussion
Striking one object against another to cause vibrations that produce sound
Any part of the body can be percussed
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15. Percussion Most commonly used for abdomen and thorax
Analyze sounds by intensity, duration, pitch

16. Quality of Sounds
Flatness
Dullness
Resonance
Hyperresonance
Tympany

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

18. 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

19. 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

20. Commonly Used Equipment
Pen and paper
Tape measure
Clean gloves
Penlight
Scale
Thermometer
Sphygmomanometer
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21. Commonly Used Equipment
Stethoscope
Otoscope
Ophthalmoscope
Visual acuity charts
Tuning fork
Reflex hammer
Lubricant

22. Preparing for a Physical Examination
Clean, professional appearance
Short fingernails
Warm hands and equipment
Ensure hair and jewelry will not interfere with the exam
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23. Preparing for a Physical Examination
Well-lit, warm, private, quiet room
Introduce self
Explain exam
Dress patient in gown, drape, and underpants
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24. Preparing for a Physical Examination
Have patient void before examination
Wash hands
Adhere to Standard and Transmission-Based Precautions
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25. 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
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26. Preparing for a Physical Examination
Proceed using a head-to-toe or other systematic approach
Thoroughly document findings
Thank patient when exam is concluded

27. 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
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28. 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
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29. Positioning for Physical Exam
Lithotomy
Use to assess female genitalia and rectum
Knee-chest
Use to assess rectum and prostate
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30. 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

31. 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
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32. Golden Rules for Physical Examination
Proceed from least invasive to most invasive
Use a systematic approach