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Chapter 8
Physical Assessment Techniques
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Competencies Describe how to maintain standard
precautions during physical assessment.
Describe how to perform inspection, palpation, percussion, auscultation, and which areas of the body are assessed with each technique.
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Competencies Establish an environment suitable
for conducting a physical assessment.
Demonstrate inspection, palpation, percussion, and auscultation in the clinical setting.
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Aspects of Physical Assessment Purposes of physical assessment
Screening of general well-being Validation of complaints that
caused the patient to seek health care
Monitoring of current health problems
Formulation of diagnoses and treatments
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Role of the Nurse Comprehensive physical assessment
vs. Focused physical assessment Utilize standard precautions during
assessment Legal issues
Accurate, complete documentation Ensure patient is properly informed of
assessment procedures
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Assessment Techniques Inspection (I) Palpation (P) Percussion (P) Auscultation (A) Usually follow order IPPA, except
for the abdomen (IAPP)
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Inspection Use of one’s senses of vision and
smell to consciously observe the patient
Careful observation
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Palpation Act of touching the patient in a
therapeutic manner Light palpation
Superficial, delicate, gentle Uses finger pads Depress 1 cm below surface Provides information on skin texture,
moisture, masses, fluid, muscle guarding, and tenderness
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Palpation Deep palpation Provide information about the position of
organs, masses, their size, shape, mobility and consistency
Uses hands Depress 4 to 5 cm below skin surface Most commonly used for assessing
abdominal and reproductive structures(continues)
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Palpation Tips
Warm hands Short nails Inform patient of when, where, and
how the touch will occur
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Percussion Striking one object against another to
cause vibrations that produce sound Analyze sounds by intensity,
duration, pitch Any part of the body can be
percussed Most commonly used for abdomen
and thorax
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Quality of Sounds Flatness Dullness Resonance Hyperresonance Tympany
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Percussion Techniques
Immediate Mediate or indirect Direct fist Indirect fist
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Auscultation Act of active listening to body organs Listening to voluntary and
involuntary sounds Quiet environment is needed to
perform Analyze sounds in relation to
intensity, pitch, duration, quality, and location
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Types of Auscultation Direct or immediate
Listening with the unaided ear Indirect or mediate
Listening with an amplication device Examples: stethoscope, doppler
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Commonly Used Equipment Pen and paper Tape measure Clean gloves Penlight Scale Thermometer Sphygmomanometer
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Commonly Used Equipment Stethoscope Otoscope Opthalmoscope Visual acuity charts Tuning fork Reflex hammer Lubricant
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Preparing for a Physical Assessment Clean, professional dress Proper identification Introduce self Well-lit, warm, private, quiet room Short fingernails Warm hands and equipment Prevent hair or jewelry from interfering with
the exam Explain exam
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Preparing for a Physical Assessment Dress patient in gown, drape, and
underpants Have patient void prior to
assessment Wash hands Adhere to standard precautions
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Preparing for a Physical Assessment Position patient as needed Avoid negative or crude remarks Be cognizant of facial expressions Perform exam in head-to-toe or
other systematic manner Thank the patient when exam is
concluded Thoroughly document findings
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Positioning for Physical Exam Fowler’s
Used to assess skin, head, neck, eyes, ears, nose, mouth, throat, thorax, lungs, heart, peripheral vasculature, neurological system
Horizontal recumbent Used to assess breasts, heart,
peripheral vasculature, abdomen, musculoskeletal system
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Positioning for Physical Exam Dorsal recumbent
Used to assess female genitalia
Lithotomy Used to assess female genitalia
Knee-chest Used to assess rectum and prostate
Sims Used to assess rectum and female genitalia
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Golden Rules for Physical Assessment Stand on the right side of the
patient to establish a dominant side for assessment
Use a head-to-toe approach Compare right to left sides of the
body for symmetry Least invasive to most invasive Systematic approach
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