During a physical examination, a health care provider studies your body to determine if you do or do not have a physical problem. Show
A physical examination usually includes: InspectionIn medical terms, “inspection” means to look at the person or body part. It is the first step in a physical exam. PalpationPalpation is a method of feeling with the fingers or hands during a physical examination. The health care provider touches and feels your body to examine the size, consistency, texture, location, and tenderness of an organ or body part. AuscultationAuscultation is listening to the sounds of the body during a physical examination. Auscultation is usually done using a tool called a stethoscope. Health care providers routinely listen to a person’s lungs, heart, and intestines to evaluate these things about the sounds:
PercussionPercussion is a method of tapping body parts with fingers, hands, or small instruments as part of a physical examination. It is done to determine:
Percussion of a body part produces a sound, like playing a drum. The sound is a sign of the type of tissue within the body part or organ.
Main Body Percussion involves tapping the body to elicit sounds and determining whether the sounds are appropriate for a particular organ or area of the body. Try tapping different surfaces with your fingertips and compare the sounds: a firm hard surface like a wood desk or table, a thick textbook, a window, or even a drum. As you tap these surfaces, you can hear that each surface elicits a different sound based on the object’s consistency. This concept also applies to the body. Each body part that you percuss provides information about the consistency as well as the size and borders of the underlying structure. For example, the percussion sounds can tell you if the organ is:
Percussion can also help reveal the presence of masses, particularly if they are close to the surface of the body. There are three approaches to percussion, but the most widely used is indirect percussion, which is the application of a mediated force using parts of both of your hands. See Figure 1.8 demonstrating the technique of indirect percussion.  Figure 1.8: Indirect percussion technique Indirect percussion is often used to assess the lungs and the abdomen (e.g., bowels, bladder, liver). The steps of this technique are as follows:
As a nurse, you need to become familiar with the expected percussion sounds so that you can identify what is normal and what is abnormal. See Figure 1.9 for the expected location of percussion sounds and Table 1.2 for an explanation of the types of percussion sounds heard including resonance, hyperresonance, tympany, dullness, and flatness. Figure 1.9: Expected location of percussion sounds Table 1.2: Percussion sounds
Another form of indirect percussion is used to assess the kidneys; this technique will be discussed in more detail when you learn about abdominal assessment. Direct percussion involves an unmediated approach with the use of only one of your hands; it is used to assess pain/tenderness associated with the sinuses or assessing the newborn/infant’s lungs. The steps of this technique involve flexing the index and pleximeter fingers of your dominant hand, and directly tapping the body’s surface with the tips of these fingers at a 90-degree angle. A third approach, tool-facilitated percussion, involves using an instrument to tap the body (e.g., a reflex hammer); this technique will be discussed in more detail when you learn about neurological assessment. You must keep your nails trimmed short to perform indirect and direct percussion so that you can perform the technique accurately and elicit a useful sound. It takes practice to perfect the technique. Keep in mind the phrase “don’t be a woodpecker” – when percussing, just use two taps on the pleximeter finger in each location, and focus on listening for sounds. With children, it is important to engage the client and incorporate play when appropriate. Percussion is one of the least used of all physical assessment techniques. It is a technique that is better confirmed using more accurate tests such as an X-ray. However, when such diagnostic tests are not readily available, such as in rural, remote or underdeveloped regions, percussion is an important non-invasive technique. Additionally, percussion is not effective when the client has a significant amount of adipose tissue or is very muscular, as these types of tissues modify the sounds you expect to hear. Which assessment technique may be used to determine the size density and location of an organ?Percussion: is tapping the patient's skin with short, sharp strokes to assess underlying structures. This technique is best used to assess location, size, and density of an organ; detect a fairly superficial abnormal mass; or elicit a deep tendon reflex.
What are the skills frequently used during the physical assessment of the patient?Here's how to do the basic four techniques
WHEN YOU PERFORM a physical assessment, you'll use four techniques: inspection, palpation, percussion, and auscultation. Use them in sequence—unless you're performing an abdominal assessment.
Which form of assessment is used to determine the border size and consistency of the organs?Moderate and bimanual palpation is used to note the size, consistency, and mobility of the structures that are palpated. Deep palpation enables the nurse to feel very deep organs or structures that are covered by thick muscles.
Which senses would the nurse use while inspecting a patient during a routine physical examination?The nurse uses touch as a tool to gather specific information about the patient during palpation and percussion. The nurse uses the sense of hearing to gather data during auscultation. Abnormal body sounds help in detecting the presence of organ pathology.
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Which assessment skill would the nurse use to determine organ density during the physical examination of a patient?
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