Chapter 3 Notes: Collecting Objective Data — The Physical Examination

Learning Objectives

  • v1: Explain how to prepare oneself, the physical environment, and the client for a physical examination.
  • v2: Survey the various pieces of equipment needed to perform a physical examination.
  • v3: Describe various client positions used for different parts of the physical examination.
  • v4: Demonstrate correct inspection, palpation, percussion, and auscultation examination techniques.
  • v5: Differentiate between light, deep, and bimanual palpation.
  • v6: Describe the purpose of direct, indirect, and blunt percussion.
  • v7: Discuss the purpose of the bell and diaphragm of the stethoscope.

Physical Examination Preparation

  • Comfortable, warm temperature.
  • Private area free of interruption.
  • Quiet area with adequate lighting.
  • Firm examination table or bed.
  • Beside table/tray to hold equipment.

Lighting and Room Setup for Assessment

  • Question #1: Is the following statement true or false? Good overhead lighting is an effective substitute for sunlight during an assessment.
  • Answer: False. It is best to use sunlight when available. However, good overhead lighting is sufficient. A portable lamp is helpful for illuminating the skin and for viewing shadows or contours.

Standard Precautions

  • Hand hygiene.
  • Gloves.
  • Mask, eye protection, face shield.
  • Gown.
  • Patient care equipment; patient placement.
  • Linen; occupational health and blood-borne pathogens.

Question #2 — Gloves and Cross‑contamination

  • Statement: There are times when gloves must be changed between procedures on the same patient.
  • Answer: True. Gloves must be changed between tasks and procedures on the same patient after contact with material that may contain a high concentration of microorganisms.

Client Approach and Preparation

  • #1
    • Establish nurse–client relationship.
    • Explain the procedure and the physical assessment that will follow, describing the steps of the examination.
    • Respect client’s requests and desires.
    • Explain the importance of the examination.
  • #2
    • Leave room while client changes clothes.
    • Provide necessary container in case of need for sample.
    • Begin exam with less intrusive procedures.
    • Explain procedure being performed.
    • Explain to client why position changes are necessary.

Client Positioning

  • Sitting position
  • Supine position
  • Dorsal recumbent position
  • Sims’ position
  • Standing position
  • Prone position
  • Knee–chest position
  • Lithotomy position

Question #3 — Sitting upright for lung expansion

  • Statement: True. Sitting upright on the side of the examination table is a useful position while examining the client as it allows full expansion of the lungs.
  • Explanation: Sitting upright on the edge of the examination table, a chair, or a bed is a good position for evaluating the head, neck, lungs, chest, back, breasts, axillae, heart, vital signs, and upper extremities. This position is also useful because it permits full expansion of the lungs and allows the examiner to assess symmetry of upper body parts.

Inspection

  • Room at comfortable temperature.
  • Good lighting.
  • Look and observe before touching.
  • Completely expose part being examined while draping the rest of the client as appropriate.
  • Note characteristics.
  • Compare appearance.

Palpation

  • #1: Palpation types
    • Light palpation
    • Moderate palpation
    • Deep palpation
    • Bimanual palpation
  • #2: Palpation characteristics (what to assess with palpation)
    • Texture (rough/smooth)
    • Temperature (warm/cold)
    • Moisture (dry/wet)
    • Mobility (fixed/movable/still/vibrating)
    • Consistency (soft/hard/fluid filled)
    • Strength of pulses (strong/weak/thready/bounding)
    • Size (small/medium/large)
    • Shape (well defined/irregular)
    • Degree of tenderness

Question #4 — Palpation depth classification

  • Question: Depressing the skin surface with the dominant hand and using a circular motion to palpate falls under which palpation type? A. Moderate palpation B. Deep palpation C. Bimanual palpation D. Light palpation
  • Answer: A. Moderate palpation. Moderate palpation involves depressing the skin surface 1 to 2 cm with the dominant hand and using a circular motion to feel for easily palpable body organs and masses.

Percussion

  • Percussion purposes
    • Eliciting pain
    • Determining location, size, and shape
    • Determining density
    • Detecting abnormal masses
    • Eliciting reflexes
  • Percussion types
    • Direct
    • Blunt
    • Indirect or mediate
  • Sounds elicited by percussion
    • Resonance
    • Hyperresonance
    • Tympany
    • Dullness
    • Flatness

Question #5 — Direct vs blunt percussion

  • Statement: Percussion that is used to detect tenderness over organs by placing one hand flat on the body surface and using the fist of the other hand to strike the back of the hand flat on the body surface is known as direct percussion.
  • Answer: False. Blunt percussion is used to detect tenderness over organs by placing one hand flat on the body surface and using the fist of the other hand to strike the back of the hand flat on the body surface.

Auscultation

  • Eliminate distracting noise.
  • Expose the body part being auscultated.
  • Diaphragm, high-pitched sounds; bell, low-pitched sounds.
  • Place earpieces into outer ear canal.
  • Angle binaurals down toward nose.

Correct Use of a Stethoscope

  • Warm diaphragm and bell before use.
  • Explain what you are listening to and answer any questions.
  • Don’t apply too much pressure when using the bell as it will cause the bell to work like the diaphragm.
  • Avoid listening through clothes.

Practical and Ethical Implications

  • Building a therapeutic relationship (trust, communication) enhances accuracy and patient comfort.
  • Respect privacy and modesty (leave room for changing clothes; proper draping).
  • Adherence to Standard Precautions reduces infection risk for patient and clinician.
  • Starting with less intrusive procedures reduces patient anxiety and improves cooperation.

Connections to Foundations and Real-World Relevance

  • Fundamentals of asepsis and patient safety in clinical assessment.
  • Observable signs (inspection) lead to hypothesis generation before invasive procedures.
  • Layered approach: inspection, palpation, percussion, auscultation—each informs the next.

Measurements and Formulas in Palpation

  • Palpation depth example: moderate palpation involves depressing the skin surface to approximately 1 to 2 cm1\text{ to }2\ \mathrm{cm} with the dominant hand.
  • Other palpation observations are qualitative (texture, temperature, mobility, tenderness, etc.).