1. DR/Magda Bayoumi

2.  The physical examination is a process during
which you use your senses to collect objective
data. You will need all of the skills of
assessment—
cognitive, psychomotor, interpersonal, affecti
ve, and ethical/legal—to perform an
accurate, thorough physical assessment.
 You also need to know normal findings before
you can begin to distinguish abnormal ones.

3.  Health history allows you to see your patient
subjectively through hers or his eyes, the
physical examination now allows you to see
your patient objectively through your
senses.
 objectively through your senses.
 The objective data complete the patient’s
health picture.

4.  The goal of physical assessment is not only to
identify actual or potential health problems but
also to discover your patient’s strengths.
 For example, you can use the physical
examination to assess clues you obtained from
the history.
 Combined with the history data, your physical
assessment findings are essential in formulating
nursing diagnoses and developing a plan of care
for your patient.

5. A complete physical assessment includes a
general survey; vital sign measurements;
assessment of height and weight; and physical
examination of all structures, organs, and body
systems. Perform it when you are examining a
patient for the first time and
need to establish a baseline.

6. A focused physical assessment zeros in on the
acute problem. You assess only the parts of
the body that relate to that problem. It is
usually performed when your patient’s
condition is unstable, as a follow-up to a
complete assessment, or when you are
pressed for time.

7.  eyes to inspect.
 ears to listen.
 hands to feel .
 Equipments.

10.  The four techniques of physical assessment
are inspection, palpation, percussion, and
auscultation.

11.  Do not rush the process;
 Take your time and really look at your patient.
 Perform inspection at every encounter with your
patient.
 Be sure you have adequate lighting,
 and sufficiently expose the area being assessed.
 Be systematic in your approach, working from head
to toe and noting key landmarks and normal findings.
Use your patient as a comparative when possible.
 Ask yourself, “Does it look the same on the left side
as the right?” Look for surface characteristics such as
color, size, and shape.
 Ask yourself, “Are there color changes?
 Is the patient symmetrical?”
 Look for gross abnormalities or signs of distress.

12.  Direct inspection involves directly looking at
your patient.
 Indirect inspection involves using equipment
to enhance visualization.

13.  During palpation, you are using your sense of touch to
collect data. Palpation is used to assess every system.
It usually follows inspection.
 Palpation allows you to assess surface characteristics,
such as texture, consistency, and temperature, and
allows you to assess for masses, organs, pulsations,
muscle rigidity, and chest excursion. It also lets you
differentiate areas of tenderness from areas of pain.

15.  Different parts of the hand are best suited for
specific purposes For example,
 The dorsal aspect of the hand is best for
assessing temperature changes ,
 The ball of the hand on the palm and ulnar
surface is best for detecting vibration and the
finger
 Pads and tips are the most discriminating for
detecting fine sensations, such as pulsations

20.  Light palpation :
Is applying very gentle pressure with the tips and
pads of your fingers to a body area and then gently
moving them over the area, pressing about 1⁄2
inch.
Light palpation is best for assessing surface
characteristics, such as
temperature, texture, mobility, shape, and size. It is
also useful in assessing pulses, areas of edema, and
areas of tenderness.

22.  Deep palpation is applying harder pressure
with your fingertips or pads over an area to a
depth greater than 1⁄2 inch. Deep palpation
can be single-handed.

23.  bimanual; When using the bimanual
technique, feel with your dominant hand. You
can place your other hand on top to help
control your movements or to stabilize an
organ with one hand while you palpate it with
the other.

24.  Deep palpation is used to assess organ
size, detect masses, and further assess areas
of tenderness.
 To assess for rebound tenderness, press down
firmly with your dominant hand and then lift
it up quickly.

25.  Ballottement is a palpation technique used
to assess a partially free-floating object.

26.  Percussion is used to assess density of
underlying structures, areas of tenderness,
and deep tendon reflexes (DTRs). It entails
striking a body surface with quick, light
blows and eliciting vibrations and sounds. The
sound determines the density of the
underlying tissue and whether it is solid
tissue or filled with air or fluid.

28.  Direct or immediate percussion is
directly tapping your hand or fingertip
over a body surface to elicit a sound or
to assess for an area of tenderness.
 Direct percussion may be used instead
of indirect percussion on an infant’s
chest. It is also used to assess for sinus
tenderness.

30.  To perform indirect or mediate percussion
, place your nondominant hand over a body
surface, pressing firmly with your middle
finger.
 Then place your dominant hand over it.
 Flexing the wrist of your dominant hand, tap
the middle finger of your nondominant hand
with the middle finger of your dominant hand.
 Do not rest your entire hand on the body
surface because this dampens the sound.
 Keep only your middle finger on the body
surface, and hyperextend it as you percuss.
Tap lightly and quickly, removing your top
finger after each tap.

34.  Direct auscultation is listening for sounds
without a stethoscope.
 indirect auscultation with a stethoscope.

37.  Always have earpieces pointing forward to seal the
ear canal. Warm your stethoscope.
 Work on the patient’s right side. This stretches your
stethoscope across the patient’s chest and minimizes
interference.
 Never listen through clothes.
 Make sure that the environment is quiet.
 If hair is a problem, wet it to minimize artifact.
 Use light pressure to detect low-pitched sounds
 Use firm pressure to detect high-pitched sounds.
 Close your eyes to help you focus.
 Learn to become a selective listener.
 Most of all—practice

38.  Workfrom head to toe, and whenever possible,
from side to side.
 Alwaysconsider the developmental stage of your
patient.
 Also be aware of cultural influences that may
affect the assessment and your findings.

39.  Also be conscious of your nonverbal behavior;
 maintain a professional demeanor and caring
attitude, and be sensitive to your patient’s
needs.
 Explain what you are doing every step of the
way, and encourage the patient to ask
questions.
 Make sure that the examination room is quiet
and private and that you will not be
interrupted.
 The room also needs to be warm.
 Ask the patient if she or he needs to void before
the examination.

40.  Provide privacy to allow your patient to change
into a gown if needed.
 While she or he is changing into a gown,
assemble all your equipment and make sure that
everything is in working order.
 Designate one area as clean for the unused
equipment and one area as dirty for the used
equipment.
 If your patient is uncomfortable removing all of
her or his clothing, allow her or him to leave
undergarments on and remove them only during
the parts of the examination when it is
necessary.

41.  Wash your hands before you begin, and wear
gloves if the possibility of exposure to blood
or body fluids exists.
 Drape your patient. Work from the right side
when possible, and expose only the area
being assessed.
 During the examination, you will use all four
techniques of physical assessment.
 If your patient has identified an area of
concern, begin there; otherwise, proceed
from head to toe.
 Do not rush. Pay attention to your patient’s
responses, both verbal and nonverbal, and
respond accordingly.

42.  Do not rush.
 Look for developmental changes.
 Do not assume. For example, your patient
may be elderly, but that does not mean he or
she is hard of hearing.
 Conserve your patient’s energy by minimizing
position changes and helping her or him
change positions as needed.
 Allow enough time for patient to respond to
questions or instructions.

43.  Identify the disability.
 Focus on the patient’s functional ability and
mental capacity.
 Modify your assessment based on the
patient’s assets and needs. For example, if
he or she is deaf, you may need to write
instructions or have someone available who
can sign.
 Be alert and sensitive to your patient’s
needs, especially if she or he is unable to
communicate verbally.