1. Chapter Three
Approach to the Physical Assessment

2. Types of Physical Assessment
Complete
Observations
Vitals signs
General appearance
Behavior
Head to toe assessment of all structures and body systems.
Focused
General Survey
Vitals signs and measurements
Assessment of the specific body structure or system.

3. Tools of the Physical Assessment
Tools we use every day
Tools you might need
Your senses are first and foremost the most important tools you have.
Stethoscope
Thermometer
Doppler
Sphygmomanometer
Pen light
Ophthalmoscope
Otoscope
Tuning fork
Tape measure
Pens
Scale
Tongue blade

4. Four techniques of physical assessment
1. Inspection
The process of being with your patient.
Look at your patient.
Be present with them.
Did you notice a strange odor from their breath?
Inspect with your eyes nose and ears.
Work from head to toe or system to system. Always use a systematic approach. Use of direct inspection is critical for all patients

5. 2. Palpation
Palpation can be just light touch in which you are looking for texture, temperature, consistency (eg: a hot area, a tense muscle, or a pulse.)
Palpation can be deep in which you are feeling for a organ structure such as the border of the liver. (Deep Palpation is > ½ inch in depth)
**Note the abdomen should never be palpated before auscultation

6. 3. Percussion
Striking a body surface with a quick light blow in order to elicit vibrations or sounds.
Direct percussion can be used to test for areas of pain (eg pain caused by renal calculus.)
It can be used to determine the density of a body structure, as well as the size and shape.
It is further used to detect deep tendon reflexes (DTRs)
Two factors influence the sound produced by percussion:
The thickness of the surface (the more tissue you percuss through—the duller the sound)
Your technique

7. 4. Auscultation Direct auscultation is done with out a stethoscope
Using your sense of hearing to obtain physical data.
Direct auscultation is done with out a stethoscope
Indirect auscultation is using a stethoscope or doppler to hear sounds not heard with the naked hear.
Tips
A Stethoscope is one of the most used tools in nursing. Use a good quality stethoscope. If your stethoscope is cheap the quality of your auscultation may be poor.
Using cheap tools is not an excuse for missing something in court.

8. Using a Stethoscope Never listen through clothes
Try and listen in a quiet environment
Use light pressure for low pitch sounds and firm pressure for high pitch sounds
Learn to block out unwanted sounds and focus on sounds you are trying to hear.
eg heart tones that are mixed in with Respirations

9. Approach to the Physical Assessment…
Should be systematic whether head to toe or system by system
Be cognitive of any special needs your patient might have.
Understand the different positions needed for different exams on pg 75 in text.

10. Components of the Physical Exam
General Survey
First impressions. Learn to listen you your Gut feelings. Use all of your senses.
Ask yourself… Are there signs of distress?
This is the time to look listen and smell.
Body type and posture
Speech
Grooming and Hygiene
Signs of mental health problems?
Look for cultural or developmental considerations.

11. Vital Signs
Respiration
Pulse
Blood pressure
Temperature
Pain scale