INTRODUCTION TO PHYSICAL

EXAMINATION

SUMAIRA GEORGE
Lecturer INS-KMU
Subject : Health Assessment l
 OBJECTIVES

By the end of the lecture students will be able to:

• Identify the general principles of conducting an examination
• Identify the equipment needed to perform a physical
examination
• Describe appropriate use of inspection, palpation, percussion
and auscultation technique during physical examination on a
patient or dummy
• Discuss Percussion and auscultation as a technique of physical
examination for eliciting various body sounds and its
appropriate use during physical examination
• Discuss the procedure & sequence for performing a general
assessment of a client
 PHYSICAL EXAMINATION

It is a medical evaluation that involves a healthcare

professional visually inspecting, palpating ( feeling with
their hands) and using their senses to assess a patient’s
physical condition. It includes:
• Vital signs (temperature, pulse, blood pressure etc)
• Inspection of body (skin, eyes, ears etc)
• Palpation ( feeling organs, joints etc)
• Auscultation (listening to sounds such as heartbeat
or breathing)
• Percussion (tapping on the body to check for sounds)
 PURPOSES OF PHYSICAL EXAMINATION

• Diagnose medical conditions

• Monitor health status
• Identify potential health problems
• Develop a treatment plan
 GENERAL PRINCIPLES OF CONDUCTING
AN EXAMINATION
To conduct a thorough and fair examination, prioritize
patient comfort clear communication, thoroughness
and adherence to ethical guidelines. Ensure a suitable
environment, maintain examiner’s position and prepare
the patient properly such as :
1. Creating Right environment including :
 Privacy and confidentiality
 Comfortable environment
 Minimize distractions
 Contii..
2.Patient comfort and well-being which includes:

 Explain the procedure

 Respect Patient autonomy
 Minimize discomfort
 Be empathetic and patient
 Contii..
3. Examiner’s position and preparation includes:
 Proper positioning
 Adequate lightening
 Cleanliness and hygiene

4. Preparing the patient includes:

 Explain the procedure
 Ensure proper exposure
 Patient comfort
 Contii..

5. Care and thoroughness includes:

 Systematic approach
 Detailed observation document findings
 Review and reflect
PHYSICAL ASSESSMENT TECHNIQUES

When you perform the physical

assessment,you’ll use four techniques:
Inspection
Palpation
Percussion
Auscultation.
Use these techniques in this Anyone
sequence except when you know
why???
perform an abdominal assessment.
 Contii..
Because palpation and percussion can alter bowel
sounds, the sequence for assessing the
abdomen is :
• Inspection,
• Auscultation,
• Percussion, and
• Palpation.
INSPECTION

• Inspect each body system using vision, smell,

and hearing to assess normal conditions and
deviations.
• Observe for color, size, location, movement,
texture, symmetry, odors, and sounds as you
assess each body system.
PALPATION
Palpation requires you to touch the patient
with different parts of your hands, using varying degrees of
pressure. Because your hands are your tools:
• Keep your fingernails short and your hands warm.
• Wear gloves when palpating mucous membranes or areas in
contact with body fluids.
• Palpate tender areas last
Types of Palpation:
 Light palpation
 Deep palpation
 Bimanual palpation
Bimanual palpation

Its purpose is to palpate breasts and deep abdominal

organs. Technique used for bimanual palpation is :
• Use two hands placing one on each side of the body
part (e.g: uterus , breast , spleen) being palpated.
• Use one hand to apply pressure and the other hand
to feel the structure.
• Note the size ,shape ,consistency and mobility of the
structures you palpate.
Use with caution as it may provoke internal injury.
 Percussion

Percussion involves tapping your fingers or hands

quickly and sharply against parts of the patient’s body
to help you locate organ borders, identify organ shape
and position, and determine if an organ is solid or filled
with fluid or gas.
 Blunt Percussion

Most commonly used method of percussion.

Its purpose is to detect tenderness over the organs. e.g:
kidneys .Technique used for blunt percussion is:

Place one hand flat on the body surface and use the fist
of the other hand to strike the back of the hand flat on
the body surface.
 Sounds Elicited by Percussion

• Resonance (heard over part air and part solid)

• e.g: normal lungs
• Hyper resonance (heard mostly over air) e.g: lung
with emphysema
• Tympany (heard over air) e.g: puffed-out cheek,
gastric bubble
• Dullness (heard over more solid tissue) e.g:
diagraphm, pleural effusion, liver)
• Flatness (heard over very dense tissue) e.g: muscle,
bone ,sternum, thigh.
Auscultation

Auscultation involves
Listening for various breath,
heart, and bowel sounds with
a stethoscope. There are two
types of auscultations:
• Direct auscultation( sounds
are audible without
stethoscope).
• Indirect auscultation( use of
Stethoscope)
Continue this survey throughout the
patient visit.
 Observe general state of health, height, build, and sexual
development.
 Note posture, motor activity, and gait; dress, grooming, and
Personal hygiene; and any odors of the body or breath.
 Watch facial expressions and note manner, affect, and
reactions to persons and things in the environment.
 Listen to the patient’s manner of speaking and note the state
of awareness or level of consciousness.
 Contii…

 Vital Signs
Ask the patient to sit on the edge of the bed or examining table,
unless this position is contraindicated.
• Stand in front of the patient, moving to either side as needed.
• Measure the blood pressure. Count pulse and respiratory
rate. If indicated, measure body temperature.
 Skin
Observe the face. Identify any lesions, noting their location,
distribution, arrangement, type, and color.
• Inspect and palpate the hair and nails. Study the patient’s
hands. Continue to assess the skin as you examine the other
body regions.
Head
Examine the
hair, scalp,
skull, and
face.
Eyes
Check visual acuity
and screen the visual
HEENT
fields. Note position,
alignment of the
eyes. Observe the
eyelids. Inspect the Ears
sclera and Inspect the
conjunctiva of each auricles,
eye.. canals, and Nose and
drums. Check sinuses
auditory Examine the
acuity.
Throat (or
external nose;
using a light and mouth and
nasal speculum, pharynx)
inspect nasal Inspect the
mucosa, lips, oral
septum, and mucosa, gums,
turbinates. teeth, tongue,
palate, tonsils,
and pharynx.
 Contii..
 Neck
Move behind the sitting patient to feel the thyroid gland and to
examine the back, posterior thorax, and lungs.
• Inspect and palpate the cervical lymph nodes. Note any
masses or unusual pulsations in the neck.
• Feel for any deviation of the trachea.
• Observe sound and effort of the patient’s breathing. Inspect
and palpate the thyroid gland.
 Back
Inspect and palpate the spine and muscles.
 Contii..
 Posterior Thorax and Lungs
Inspect and palpate the spine and muscles of the upper back.
Inspect, palpate, and percuss the chest.
• Identify the level of diaphragmatic dullness on each side.
• Listen to the breath sounds; identify any adventitious (or added)
sounds, and, if indicated, listen to transmitted voice sounds.
 Breasts, Axillae
The patient is still sitting. Move to the front again.
• In a woman, inspect the breasts with patient’s arms relaxed,
then elevated, and then with her hands pressed on her hips.
• In either sex, inspect the axillae and feel for the axillary nodes.
 Contii..
 Anterior Thorax and Lungs
The patient position is supine. Ask the patient to lie down. Stand at the
right side of the patient’s bed.
• Inspect, palpate, and percuss the chest. Listen to the breath sounds,
any adventitious sounds, and, if indicated, transmitted voice sounds.

 Cardiovascular System
Elevate head of bed to about 30 degrees, adjusting as necessary to see
the jugular venous pulsations.
• Observe the jugular venous pulsations, and measure the jugular
venous pressure in relation to the sternal angle.
• Inspect and palpate the carotid pulsations. Listen for carotid bruits.
 Contii..
 Abdomen
Lower the head of the bed to the flat position. The patient should be supine.
• Inspect, auscultate, and percuss. Palpate lightly, then deeply. Assess the liver
and spleen by percussion and then palpation.
• Try to feel the kidneys; palpate the aorta and its pulsations.
 Peripheral Vascular System
With the patient supine, palpate the femoral pulses and, if indicated, popliteal
pulses. Palpate the inguinal lymph nodes.
• Inspect for edema, discoloration, or ulcers in the lower extremities. Palpate
for pitting edema. With the patient standing, inspect for varicose veins.
 Lower Extremities
Examine the legs, assessing the three systems while the patient is still supine.
Each of these systems can be further assessed when the patient stands.
 Contii..
 Nervous System
The patient is sitting or supine. The examination of the nervous system can
also be divided into the upper extremity examination (when the patient is still
sitting) and the lower extremity examination (when the patient is supine)
after examination of the peripheral nervous system.

 Mental Status
If indicated and not done during the interview, assess orientation, mood,
thought process, thought content, abnormal perceptions, insight and
judgment, memory and attention, information and vocabulary, calculating
abilities, abstract thinking, and constructional ability.
 Contii..
 Cranial Nerves
If not already examined, check sense of smell, funduscopic examination,
strength of the temporal and masseter muscles, corneal reflexes, facial
movements, gag reflex, strength of the trapezia and sternomastoid muscles,
and protrusion of tongue.
 Motor System
Muscle bulk, tone, and strength of major muscle groups. Cerebellar function:
rapid alternating movements (RAMs), point-to-point movements such as
finger to nose (F → N) and heel to shin (H → S); gait. Observe patient’s gait
and ability to walk heel to toe, on toes, and on heels; to hop in place; and to
do shallow knee bends.
 Sensory System
Pain, temperature, light touch, vibrations, and discrimination. Compare right
and left sides and distal with proximal areas on the limbs.
 Contii..
Rectal and Genital examinations
Often performed at the end of the physical examination.
• Male Genitalia and Hernias
Examine the penis and scrotal contents. Check for hernias. Rectal Examination
in Men. The patient is lying on his left side for the rectal examination. Inspect
the sacrococcygeal and perianal areas.
• Genital and Rectal Examination in Women
The patient is supine in the lithotomy position. Sit during the examination
with the speculum, then stand during bimanual examination of uterus,
adnexa, and rectum. Examine the external genitalia, vagina, and cervix.
Obtain a Pap smear. Palpate the uterus and adnexa. Do a bimanual and rectal
examination.
Documentation
Documentation
 Documentation

• SKIN: Multiple hyperpigmented macules on the chest, one with irregular

borders.
• HEENT: Normocephalic, pharynx erythematous with white exudates.
• Neck: Supple, but with a palpable, tender lymph node on the right side.
• Lungs: Decreased breath sounds on the left lower lung field with mild
wheezing. C.V.S: S1, S2 heard, but with a Grade II systolic murmur. No S3,
S4.
• Abdomen: Active bowel sounds, but mild tenderness in the right upper
quadrant with hepatomegaly.
• Extremities: Bilateral pitting edema (+2) on lower limbs.