Preparing for the Examination

3 ASPECTS OF PREPARATION − Preventing the transmission of

infectious agents.
− Always wear gloves if there is a
• Preparing the physical setting
chance that you will come in direct
• Preparing oneself
contact with blood or other body
• Approaching and preparing the client
fluids.
PREPARING THE PHYSICAL SETTING − If a pin or other sharp object is used
to assess sensory perception, discard
the pin and use a new one for your next
− Comfortable, warm room client.
temperature: Provide a warm blanket − Wear a mask and protective eye
if the room temperature cannot be goggles if you are performing an
adjusted. examination in which you are likely to
− Private area free of interruptions from be splashed with blood or other
others: Close the door or pull the body fluid droplets (e.g., if you are
curtains if possible. Quiet area free of performing an oral examination on a
distractions: Turn off the radio, client who has a chronic productive
television, or other noisy equipment. cough).
− Adequate lighting: It is best to use
sunlight (when available). However, APPROACHING AND PREPARING THE
good overhead lighting is sufficient. A CLIENT
portable lamp is helpful for illuminating
the skin and for viewing shadows or − Establish the nurse–client
contours. relationship during the client interview
− Firm examination table or bed at a before the physical examination takes
height that prevents stooping: A roll-up place.
stool may be useful when it is − This is important because it helps to
necessary for the examiner to sit for alleviate any tension or anxiety that
parts of the assessment. the client is experiencing.
− A bedside table/tray to hold the − At the end of the interview, explain to
equipment needed for the examination. the client that the physical assessment
PREPARING ONESELF will follow and describe what the
examination will involve.

− Assess your own feelings and PREPARING THE PATIENT

anxieties before examining the client.
− Achieve self-confidence in performing − Explanation about the procedure
a physical assessment by practicing the − When and where it will take place
techniques on a classmate, friend, or − Importance
relative.
− What will happen during examination,
− Encourage your “pretend client” to and it is painless
simulate the client role as closely as
− Empty the bladder
possible.
− Sequence of assessment differ with
children and adult
 DRAPING INSPECTION

Drapes are made up of paper, cloth or bed − Concentrated watching/observing

linen. Drapes should be arranged so that the − Always comes first
area to be assessed is exposed and other − A focused inspection takes time and
body areas are covered. yields a surprising amount of data
− Requires good lighting, adequate
PHYSICAL EXAMINATION TECHNIQUES
exposure, and occasional use of certain
• Inspection instruments ( penlight, otoscope) to
enlarge your view
• Palpation
• Percussion To use the senses of vision, smell, and hearing
• Auscultation to observe the normal condition or any
deviations from normal of various body parts.
 • Expose body parts being observed • DORSA of hands-Temperature
while keeping the rest of the client detection
properly draped. • BASE of fingers or ulnar surface of
• Always look before touching. hands-vibration
• Use good lighting.
• Provide a warm room with good
ventilation
• Observe for color, size, location,
texture, symmetry, odors, and sounds.

PALPATION

− Using touch to detect variations in

normal and investigate abnormalities
− Should be slow and systematic
− Gentle, calm approach starting with
light palpation
− Be alert; short nails

To touch and feel body parts with hands to

determine the following characteristics:

a. texture (roughness/smoothness)

b. temperature (warm/hot/cold)

c. moisture (dry,wet, or moist)

d. motion (stillness/vibration)

e. consistency of structures (solid/fluid

filled)

Palpation Technique
▪ Examiner’s fingernails should be short

▪ The most sensitive part of the hand

should be used to detect various
sensations

▪ Light palpation precedes deep

palpation

▪ Tender areas are palpated last

Sense of Touch
• FINGERTIPS- Fine tactile
discrimination-skin texture, swelling,
lumps
 PERCUSSION AUSCULTATION
− eliciting pain − Listening to sounds produced by the
− determining location body
− determining density − Use stethoscope to amplify sounds
− detecting abnormal masses − Become familiar with bell and
− eliciting reflexes diaphragm
− Use tubing that is 12-18 inches long
− Warm chestpiece before using
− Keep instrument clean
− Better to listen under a gown than thru
a gown

To listen for various breath, heart, and bowel

sounds using a stethoscope.

Use a good stethoscope that has:

• Snug-fitting ear plugs

• Tubing not longer than 15 inches and
internal diameter not greater than inch
• Diaphragm and bell

STETHOSCOPE
• DIAPHRAGM-high pitched sounds
• BELL- soft, low-pitched sounds like
murmurs or extra heart sounds
• EARPIECES-point toward your nose

These Guidelines Should Be Followed As

You Practice The Technique Of
Auscultation:

o Eliminate distracting or competing

noises from the environment (e.g.,
radio, television, machinery).
o Expose the body part you are going to
auscultate. Do not auscultate through
the client’s clothing or gown. Rubbing
against the clothing obscures the body
sounds.