PHYSICAL

EXAMINATION
BY
MAGNUS CHINEDU APUANU
PhD(c), DPA(c), MSc.(Midwifery), MSc.(OH&S), MSc.(Medical Education), MPA(Executive), MPH, PGDE,
PGCert(Nuclear Science), AdvDip(Critical Care Nursing), BNSc, RN, RM, RPHN, RCCN, RNE, AEP,
CMC, MNIM, MISPN, FIMC, FCP.

NSC 301.1: MEDICAL-SURGICAL NURSING I

DEPARTMENT OF NURSING
UNIVERSITY OF PORT HARCOURT
 Physical Examination
1
Introduction/Definition
2
Purpose of Physical Examination
3
Techniques of Physical Examination
4
Systems Approach to Physical Examination
 LEARNING OBJECTIVE

 Understand the various techniques used in

physical examination
 ASSIGNMENT

 A well-crafted video of you carrying out the functional

health patterns component of patient assessment.
 Your patient can be a friend, sibling, neighbour, etc.
 The video should be very clear and the sound very
audible.
 Submission deadline: 11:59PM, 14th Dec. 2024.
 Submission link will be provided on a later date.
 Introduction
 Physical assessment is an organized systematic
process of collecting objective data.
 It is a fundamental aspect of patient care, involving
the systematic assessment of a patient's body systems
to gather objective data about their health status.
 The purpose of the physical examination is to
determine changes in a patient’s health status and
how to respond to a problem as well as promote
healthy lifestyles and wellbeing.
 Introduction
 A physical examination can be any of three types:
 (1) a complete assessment (e.g., when a client is
admitted to a hospital)
 (2) examination of a body system (e.g., the
cardiovascular system)
 (3) examination of a body area (e.g., the lungs, when
difficulty with breathing is observed)
Purpose of Physical Examination
 To obtain baseline data about the client’s functional
abilities.
 To supplement, confirm, or refute data obtained in the
nursing history.
 To obtain data that will help establish nursing diagnoses
and plans of care.
 To evaluate the physiological outcomes of health care and
thus the progress of a client’s health problem.
 To make clinical judgments about a client’s health status.
 To identify areas for health promotion and disease
prevention
 Techniques of Physical
Examination
 Four primary techniques used in the physical
examination are: inspection, palpation, percussion,
and auscultation.
 These four techniques will always be utilized in order
in all systems with the exception of the abdomen.
 During the abdominal examination, the pattern will be
inspection, auscultation, percussion, and palpation.
 Auscultation follows inspection so as not to increase
bowel motility with palpation.
 1. Inspection
 Inspection is concentrated watching.
 It is the visual examination, which is assessing by using
the sense of sight.
 The nurse inspects with the naked eye and with a lighted
instrument such as an otoscope (used to view the ear).
 Nurses frequently use visual inspection to assess
moisture, colour, and texture of body surfaces, as well as
shape, position, size, and symmetry of the body.
 Lighting must be sufficient for the nurse to see clearly;
either natural or artificial light can be used.
An otoscope for visualizing the eardrum and the external ear canal
 2. Palpation
 Palpation is the examination of the body using the sense of
touch.
 Palpation is used to determine:
 Texture (e.g., of the hair)
 Temperature (e.g., of a skin area)
 Vibration (e.g., of a joint)
 Position, size, consistency, and mobility of organs or masses
 Distention (e.g., of the urinary bladder);
 Pulsation
 Tenderness or pain.
 2. Palpation
 Different parts of the hands are best suited for
assessing different factors.

Parts of the Hand Used in

Palpation
2. Palpation
 Fingerpads—Best for fine
tactile discrimination, as of
skin texture, swelling,
pulsation, and
determining presence of
lumps.
 A grasping action of the
fingers and thumb—To
detect the position, shape,
and consistency of an
organ or mass.
Grasping action of the fingers and thumb
2. Palpation
 The dorsa (backs) of
hands and fingers—Best
for determining
temperature, because
the skin here is thinner
than on the palms.
 Base of fingers
(metacarpophalangeal
joints) or ulnar surface
of the hand—Best for
vibration as fremitus.
Determining temperature of the skin
 2. Palpation
 There are three types of palpation: light, moderate and
deep.
 Light (superficial) palpation is used to assess superficial
structures and detect tenderness, swelling, skin texture,
pulse, or abnormalities.
 It involves applying minimal pressure with the finger
pads to the skin and underlying tissues, typically using a
circular or back-and-forth motion.
 The hand is moved slowly, and the finger pads, at a
depth of 1 cm (0.39 in.), form circles on the skin during
assessment.
 2. Palpation
 Examples of light palpation include the following:
 Checking peripheral pulses
 Checking for tenderness in abdominal examination
 Detecting superficial masses (lumps) or abnormalities
near the skin's surface.
 Assessing skin texture for irregularities like rashes,
swelling, or firmness.
 Detecting edema, e.g pitting edema
 Assessing muscle tone – Gently pressing on superficial
muscles to evaluate tension or tenderness
 2. Palpation
 Moderate palpation is used to assess structures
located just beneath the skin.
 For moderate palpation, the nurse uses moderate
pressure, places the palmar surface of the fingers of
the dominant hand over the structure to be assessed,
and presses downward approximately 1 to 2cm
(approximately 0.4 to 0.75 in.), rotating the fingers in a
circular motion.
 Now the nurse can determine the depth, size, shape,
consistency, and mobility of organs as well as any
pain, tenderness, or pulsations that might be present.
 2. Palpation

 Examples of moderate
palpation
 Clinical breast examination
 Assessing bladder fullness
or tenderness

Clinical breast exam

 2. Palpation
 Deep palpation is used to assess deeper structures within the
body.
 It involves applying firm pressure with the finger pads or the
palm of the hand at 2 to 4 cm (approximately 0.75 to 1.5 in.) to
feel for organs, masses, or abnormalities that lie beneath the
surface.
 Deep palpation is commonly used in abdominal examinations
to assess the size and location of abdominal organs, such as
the liver, spleen, and kidneys.
 It can also be used to assess deep muscle or tissue injuries,
identify masses or tumors, or evaluate structures within the
pelvis during gynecological examinations.
 2. Palpation
 Light palpation should always precede deep palpation
because heavy pressure on the fingertips can dull the
sense of touch.
 Deep palpation is usually not done during a routine
examination and requires significant practitioner skill.
 It is performed with extreme caution because
pressure can damage internal organs.
 It is usually not indicated in clients who have acute
abdominal pain or pain that is not yet diagnosed.
General Guidelines for Palpation
 The nurse’s hands should be clean and warm, and the
fingernails short. Warm your hands prior to placing them on
the patient.
 Encourage the patient to continue to breathe normally
throughout the palpation.
 Areas of tenderness should be palpated last
 Deep palpation should be done after superficial palpation.
 Be sensitive to the client’s verbal and facial expressions
indicating discomfort. If pain is experienced during the
palpation, discontinue the palpation immediately.
 Inform the patient where, when, and how the touch will occur,
especially when the patient cannot see what you are doing
 3. Percussion
 Percussion comes from the Latin word percutire,
meaning “to strike through.”
 Percussion is the act of striking the body surface to elicit
sounds that can be heard or vibrations that can be felt.
 The nurse strikes through a body part with an object,
fingers, or reflex hammer, ultimately producing a
measurable sound.
 The striking or tapping of the body produces sound
waves. As these waves travel toward underlying
structures, they are heard as characteristic tones.
 3. Percussion
 The procedure is similar to a musician striking a drum,
creating a vibration heard as a musical tone
 There are three types of percussion: direct, blunt and
indirect.
 For 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.
 The strikes are rapid, and the movement is from the wrist.
 Direct percussion is used to examine the thorax of an
infant and to assess the sinuses of an adult.
Percussing the sinuses
3. Percussion
 Blunt percussion involves placing
the palm of the nondominant
hand flat against the body surface
and striking the nondominant
hand with the dominant hand.
 A closed fist of the dominant
hand is used to deliver the
blow.
 This method is used for assessing
pain and tenderness in the
gallbladder, liver, and kidneys.
 3. Percussion
 Indirect percussion is the striking of
an object (e.g., a finger) held against
the body area to be examined.
 A hammer or tapping finger used to
strike an object is called plexor,
derived from the Greek word plexis.
 Pleximeter, derived from the Greek
word metron, meaning “measure,”
refers to the device that accepts the
Indirect percussion
tap or blow from a hammer.
 3. Percussion
 In the indirect technique, the middle finger of the
nondominant hand (the pleximeter) is placed firmly
on the client’s skin.
 Using the tip of the flexed middle finger of the other
hand (the plexor)
 The striking motion comes from the wrist; the forearm
remains stationary.
 The angle between the plexor and the pleximeter
should be 90°, and the blows must be firm, rapid, and
short to obtain a clear sound.
 Guidelines for Percussion
 Indirect percussion is the technique most commonly used
because it produces sounds that are clearer and more
easily interpreted.
 Ensure that motion is from the wrist, not the forearm or
plexor finger.
 Release the plexor finger immediately after the delivery
of two sharp strikes.
 Ensure that only the pleximeter makes contact with the
body.
 Use the tip of the plexor finger, NOT the finger pad, to
deliver the blow.
 Percussion Sounds
 Percussion is used to determine the size and shape of
internal organs by establishing their borders.
 It indicates whether tissue is fluid filled, air filled, or
solid.
 The amount of air in the underlying structure being
percussed is responsible for the tone being produced.
 The more dense the tissue is, the softer and shorter
the tone. The less dense the tissue is, the louder and
longer the tone.
 Tympany

Percussion
Resonance

Hyperresonance

Dullness

Flatness
 Percussion Sounds
 Tympany is a loud, high-pitched,
drum-like sound from an air-filled
organ, like the stomach.
 Tympany is normal over the
stomach (gastric bubble) or
intestines.
 Excessive tympany could suggest
bowel obstruction or excessive gas
Musical drum
 Tympany over the thorax (chest)
may indicate pneumothorax.
 Percussion Sounds
 Resonance is a loud, low-pitched, hollow
tone of long duration, produced by lungs
filled with air.
 It is the normal finding over the lungs as
it indicates normal lung function and air
content.
 Hyperresonance is an abnormally loud, low
Lungs tone of longer duration than resonance.
 It is heard when air is trapped in the lungs.
E.g, emphysema, status asthmaticus.
 Percussion Sounds
 Dullness is a thud-like sound produced by dense
tissue such as the liver, spleen, or heart.
 Suggests the presence of fluid, solid organs, or masses
(pleural effusion, pneumonia, or tumor)
 Flatness is an extremely dull sound produced by very
dense tissue, such as muscle or bone.
 On a continuum, flatness reflects the most dense
tissue (the least amount of air) and tympany the least
dense tissue (the greatest amount of air).
 4. Auscultation
 Auscultation is the process of listening to sounds
produced within the body.
 Auscultation may be direct or indirect.
 Direct auscultation is performed using unassisted
sense of hearing (the unaided ear), for example, to
listen to a respiratory wheeze or the grating of a
moving joint.
 Indirect auscultation is performed using a
stethoscope, which transmits sounds to the nurse’s
ears.
 4. Auscultation
 A stethoscope is used primarily to listen to sounds
from within the body, such as bowel sounds or valve
sounds of the heart and blood pressure.
 The stethoscope tubing should be 30 to 35 cm long,
with an internal diameter of about 0.3 cm.
 It should have both a flat-disk diaphragm and a bell-
shaped amplifier.
 The diaphragm best transmits high-pitched sounds
(e.g., bronchial sounds), and the bell best transmits
low-pitched sounds such as some heart sounds.
 4. Auscultation
 Auscultated sounds are described according to their pitch,
intensity, duration, and quality.
 The pitch is the frequency of the vibrations (the number of
vibrations per second).
 Low-pitched sounds, such as some heart sounds, have fewer
vibrations per second than high-pitched sounds, such as
bronchial sounds.
 The intensity (amplitude) refers to the loudness or softness of
a sound.
 Some body sounds are loud, e.g, bronchial sounds heard from
the trachea; others are soft, e.g, normal breath sounds heard
in the lungs (vesicular sound).
 4. Auscultation
 The duration of a sound is its length (long
or short).
 The quality of sound is a subjective
description of a sound, for example,
whistling, gurgling, or snapping.
 In auscultation, the diaphragm and bell of
the stethoscope are used to detect the
characteristics of heart, lung, and bowel
sounds.
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Systems Approach to
Physical Examination
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