HEALTH ASSESSMENT: PRELIM TRANSCRIPTION

CHAPTER III :
COLLECTING OF OBJECTIVE DATA:
PHYSICAL EXAM TECHNIQUES
NURSING DATA COLLECTION, DOCUMENTATION, ANALYSIS
LECTURER: DR. ELIZALDE D. BANA, MD, RN, MN, MAN
DATE OF LECTURE: 02/06/24

OUTLINE EQUIPMENTS NEEDED FOR

PHYSICAL EXAMINATION
I. EQUIPMENT
II. PREPARING FOR THE PHYSICAL
EXAM
PREPARING THE PHYSICAL SETTING
PREPARING ONESELF
APPROACHING AND PREPARING THE
CLIENT
PHYSICAL EXAMINATION
TECHNIQUES
INSPECTION
PALPATION
PERCUSSION
AUSCULTATION
SUMMARY

collecting Objective Data PRESSURE ULCER SCALE

FOR HEALING

Objective data include information about

the client that the nurse directly observes
during interaction with the client and
information elicited through physical
examination techniques.

BASIC KNOWLEDGE NEEDED FOR PHYSICAL

EXAMINATION
Types and operation of equipment needed
for the particular examination (e.g.,
penlight, sphygmomanometer, otoscope,
tuning fork, stethoscope)
Preparation of the setting, oneself, and the
client for the physical assessment
Performance of the four examination
techniques: inspection, palpation,
percussion, and auscultation
 EQUIPMENTS NEEDED FOR
PHYSICAL EXAMINATION PREPARING ONESELF
STANDARD PRECAUTIONS IN HEALTH CARE
Standard precautions, guided by risk
EXAMINATION EQUIPMENT PURPOSE
assessment, use common-sense practices
and protective equipment to shield
healthcare providers and prevent
infection spread among clients.

1. HAND HYGIENE
Hand hygiene involves cleaning hands
using handwashing, antiseptic handwash,
antiseptic hand rub, or surgical hand
antisepsis.
Reduces the spread of germs to clients and
the risk of healthcare provider infection.

2. ALCOHOL-BASED HAND SANITIZER USE:

Use before touching a client, performing

aseptic tasks, moving between body sites,
after contact with blood or contaminated
surfaces, and after glove removal.
Apply product, rub hands until dry (about
20 seconds).

3. HANDWASHING:
Wash with soap and water when hands are
visibly soiled or after exposure to
PREPARING FOR THE infectious agents.
Wet hands, apply recommended amount of
EXAMINATION soap, rub hands for at least 15 seconds,
rinse, and dry with disposable towels.
Prepare the physical setting, yourself,
and the client to elicit quality data and 4. GLOVE USE:
Wearing of gloves when in contact with
support clinical judgments. Practice
infectious materials is anticipated, but not
with others to achieve proficiency in all a substitute for hand hygiene.
three aspects of preparation. Perform hand hygiene before and after
glove use; change gloves if damaged,
PREPARING THE PHYSICAL SETTING soiled, or moving between body sites.
Comfortable room temperature Never wear the same pair for more than
one client.
Private area free of interruptions
from others 5. SKIN AND NAIL CARE:
Quiet area free of distractions Lotions and creams prevent skin dryness;
Adequate lighting use approved ones.
Firm examination table or bed at a Avoid artificial fingernails, keep natural
height that prevents stooping nails short.
A bedside table/tray to hold the Rings may harbor germs; further research
equipment needed for the needed.
examination.
6. RESPIRATORY HYGIENE/COUGH 2. SUPINE POSITION
ETIQUETTE:
- This position allows the abdominal muscles
Cover mouth/nose when
to relax and provides easy access to
coughing/sneezing, and dispose of tissues
properly.
peripheral pulse sites. Areas assessed with
Perform hand hygiene after contact with the client in this position may include head,
respiratory secretions. neck, chest, breast, axillae, abdomen, heart,
Health facilities should provide materials lungs, and all extremities axillae.
for respiratory hygiene in waiting areas.

APPROACHING AND PREPARING THE

CLIENT
Establish the nurse-client relationship
during the interview before the
physical examination to ease client
tension.
3. DORSAL RECUMBENT POSITION
Conclude the interview by explaining
the upcoming physical assessment and - This position may be more comfortable
providing specific instructions. than the supine position for clients with pain
in the back or the abdomen. Areas that may
assess with the client in this position include
head, neck, chest, axillae, lungs, heart,
extremities, breast, and peripheral pulses.
Positioning the Client The abdomen should not be assessed
because the abdominal muscles are
contracted in this position.

1. SITTING POSITION
This position is good for evaluating the head,
neck, lungs, chest, back, breast, axillae, heart,
vital signs, and upper extremities.

4. SIM’S POSITION

- Useful for assessing the rectal and

vaginal areas. Clients with joint problems
and elderly clients may have some
difficulty assuming and maintaining this
position.
 Positioning the Client 7. KNEE-CHEST POSITION
- Useful for examining the rectum. This
position may be embarrassing and
uncomfortable for the client therefore, the
5. STANDING POSITION client should be kept in the position for as
limited a time as possible. Elderly clients and
- This position is good for evaluating the head, clients with respiratory and cardiac problems
neck, lungs, chest, back, breast, axillae, heart, may be unable to tolerate this position.
vital signs, and upper extremities.

8. LITHOTOMY POSITION
- Used to examine the female genitalia
reproductive tracts and the rectum.

6. PRONE POSITION

- Used primarily to assess the hip joint. The

back can also be assessed with the client in
this position. Clients with cardiac and
respiratory problems cannot tolerate this
position.

Physical Examination
Technique

Before you can conduct a thorough and

comprehensive assessment of the client, you
need to be proficient in four fundamental
techniques. These methods include
auscultation, percussion, palpation, and
inspection (IPPA). Inaccurate application of
these examination techniques may lead to
inaccurate objective data collection, poor
clinical judgment, and ultimately, a negative
impact on the provision of safe client care.
 Deep Palpations
PHYSICAL EXAMINATION
Gives you the ability to feel organs or other
TECHNIQUES structures that are buried deep beneath layers of
muscle.
1. INSPECTION
- entails employing the senses of hearing,
smell, and vision to observe and distinguish
any normal or abnormal findings. Palpation,
percussion, and auscultation are performed
subsequent to inspection, as the latter
techniques may alter the appearance of the
Bimanual Palpations
object being examined.
- Use two hands, placing one on each side of the
body part.
2. PALPATIONS
- Consists of using parts of the hand to touch
and feel for the following characteristics.

Light Palpations
- Involves feeling and touching various hand
parts for the following characteristics.

Parts of Hand to Use when Palpating

• Fingerpads: small differences in size,
consistency, shape, texture, pulses, and
crepitus.
• The palmar or ulnar surface: thrills, vibrations,
and fremitus
Moderate Palpations • Dorsal surface (back) temperature
To feel for masses and organs that are readily
palpable, move your hand in a circular motion. 3. PERCUSSION
- Involves making sound waves by tapping
specific body parts. Examiners can evaluate
underlying structures thanks to these sound
waves or vibrations. There are various
applications for percussion in assessment,
such as the following:
• Eliciting pain: Percussion aids in the
identification of inflammatory substructures.
When an inflammatory area is percussionated,
the client may report or show physical signs of
tenderness, soreness, or pain in that area.
• Determining size, shape, and location:
Percussion note variations between an organ's
border and that of its adjacent organ can provide
information about an organ's size, shape, and
location.
• Determining density: Percussion is used to 4. AUSCULTATION
ascertain whether an underlying structure that is
- necessitates using a stethoscope to listen for
filled with fluid or air is solid or not.
heartbeats, blood flow via the cardiovascular
• Eliciting reflexes: The percussion hammer is
system, bowel movements, and airflow via the
used to elicit deep tendon reflexes.
respiratory tract. Since these body sounds are
3 TYPES OF PERCUSSIONS inaudible to the human ear, a stethoscope is
Direct Percussion used. Auscultation is used to detect sounds,
- the direct application of one or two fingertips to which are then categorized based on their
a body part in order to detect any potential intensity (loud or soft), pitch (high or low),
tenderness. duration (length), and quality (musical, crackling,
raspy).

Blunt Percussion
- is performed by placing one hand flat on the
body and striking the back of the hand flat on the
body with the other hand's fist to identify any
SUMMARY
tenderness over the organs. Collecting objective data is essential for a complete nursing
assessment. The nurse must have knowledge of and skill in
three basic areas to become proficient in collecting objective
data: necessary equipment and how to use it; preparing the
setting, oneself, and the client for the examination; and how to
perform the four basic assessment techniques. Collecting
objective data requires a great deal of practice to become
proficient. Proficiency is needed because how the data are
collected can affect the accuracy of the information elicited.

--End of Transcript--
Indirect Percussion
The most popular type of percussion is indirect
or mediate percussion. The sound or tone
produced by tapping with this kind of percussion
changes according to the density of underlying
GROUP MEMBERS
structures. CANASA, APRIL GRACE
ATILLO, ALEXANDER JAMES
MANREZA, CHELSEA

REFERENCES:
Weber,J.R.,&Kelley,J.H.(2022). HealthAssessment
inNursing(7thed.).Wolters Kluwer.
Burke, A. (2023, August 27). "Techniques of Physical

Assessment: NCLEX-RN": Registered Nursing.

ORG.
https://www.registerednursing.org/nclex/techniq
ues-physical-assessment/