Assessment Techniques

What are the 4 basic techniques of physical examination?

Inspection, Palpation, Percussion, Auscultation

What should be done first during inspection?

Begins when you first meet the person with general survey

Start with assessment for each body system!

ALWAYS THE FIRST THING YOU DO!!!!

General inspection

Observing the pt from front to back and from each side, checking for symmetry of body parts, obvious injuries, abnormalities, overall appearance

Systemic inspection

inspecting each body area systemically from head- to-toe; AKA HEAD TO TOE ASSESSMENT !!!!

Focused inspection

Perform general inspection and then only perform inspection on affected body system (think: ER; they don’t do a full Head to Toe. They only focus on your Chief Complaint

What are the inspection guidelines?

• Make sure you have good lighting– can be daylight or artificial

• Conduct an unhurried and careful inspection

• Expose only what you want to inspect (don’t completely uncover them)

• Validate findings with the pt

  • It’s okay to ask your patient questions. Makes sure you’re getting correct info while also making sure they’re aware of their own health

• Ensure you have appropriate equipment to perform assessment

• HAND HYGIENE!! Use glovesssss!

Applies sense of touch to assess:

• Applies sense of touch to assess the following

  • Texture, temperature, moisture

  • Organ location and size

  • Swelling, vibration, pulsation, crepitation

  • Rigidity and spasticity

  • Presence of lumps or masses

  • Presence of tenderness or pain

• Should be performed slow and systematic

  • start with light palpation and then go deep

  • Bimanual palpation is used for certain body parts or organs

What are the guidelines for palpation?

• Palpation is a technique using the hands and fingers to gather information through the sense of touch.

• Keep fingernails short

• Have warm hands and be gentle

• Use correct palpation depth and the appropriate part of the hand to correctly identify findings without producing unnecessary discomfort to the patient.

Palpation considerations

• Typically follows inspection

• When assessing the abdomen, always perform palpation after inspection and auscultation

  • palpation may increase the pt’s intestinal activity, causing misleading auscultation findings, like increased bowel sounds

• Gloves should be worn

• Touch can also have cultural significance

  • If pt’s culture views touch as not acceptable, nurse has to respect this and gather what they can w/o touching

Areas of the hand:
Palmar surface of the fingers and finger pads

Position, texture, size, consistency, fluid, crepitus, form of a mass, or structure

Areas of the hand:

Ulnar surfaces of hand and fingers

Vibration

Areas of the hand:

Dorsal surface of hand

Temperature

Areas of the hand:

Entire hand

Muscle strength

Fingertips

best for tactile discrimination of skin texture, swelling, pulsation, determining presence of lumps

Fingers and thumb

detection of position, shape, and consistency of an organ or mass

Dorsa of hands and fingers

best for determining temp b/c skin is thinner here than the palm

Base of the fingers or ulnar surface of the hand

best for vibration

Light palpation

pressing down 1 cm. Used to assess moisture, texture, temp, pulsations, tenderness, superficial masses and lesions

Deep palpation

press down 4 cm with 1 or 2 hands to determine organ size and contour (liver)

Percussion

Uses sound waves to gather info about the density of tissue

Other Percussion tips

• Can be direct or indirect and is used to evaluate the size and borders of internal organ

• Can also provide info about tenderness or the amount of fluid w/in a body cavity

• Tapping person’s skin with short, sharp strokes to assess underlying structures

• Sound waves arise from vibrations and produce percussion tones

• Has the following uses:

  • Mapping location and size of organs

  • The tone/note heard is related to density of underlying tissue

  • Detecting a superficial abnormal mass (deeper masses would give no change in percussion)

  • Pain if underlying structure is inflamed

What are the characteristics of sounds?

Amplitude (intensity)- loud or soft

Pitch (frequency)- number of vibrations per second

Quality- subjective difference

Duration- length of time sound lingers

What are the basic principles of sound?

Structure with more air produces louder, deeper sound compared with denser structure

There me variations because of anatomical differences between everyone

Remember this chart

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What are the basic principles for auscultation?

• Stethoscope does not magnify sound but blocks extra sounds

• Eliminate extra sound (touch stethoscope to skin). NEVER ON THE GOWN

• Listen to one sound at a time and distinguish the sound you are auscultating

• Make sure environment is quiet

• Do not anticipate the next sound or what you expect to hear next

How to distinguish sound for auscultation?

• Take time to identify, including the intensity, duration, pitch, quality

  • Intensity- loudness of the sound (soft, medium, loud)

  • Pitch- frequency of the sound waves generated per second

    • High pitched- high frequencies

    • Low pitched- low frequencies

  • Duration- length that sound is heard (short, medium, long)

  • Quality- description of the sounds. Also includes murmur or crackles