Techniques of Physical Assessment (Nursing)

00:02 Hi! Today, we’re going to be talking about techniques of physical assessment. My name is Jill Beavers-Kirby. First, we want to know why do we do a physical assessment. This is to evaluate the patient’s current health status, to clarify the physical data, and to determine the interventions based on this data.

00:24 So in what order do we do a physical assessment? First, we inspect, then we palpate, then percuss, then auscultate. This order is slightly different when assessing the abdomen. First, we inspect, auscultate, percuss, and then palpate. So, what is inspection? Inspection is the visual exam. It begins with the first interaction. You will use all of your senses including vision, hearing, and smell. You want to make sure that the inspection occurs in a well lit area. Next is palpation. We’ll discuss light palpation first. This is the actual hands-on exam. You want to make sure that you keep your fingernails short and clean and keep your hands warm. You’ll start with light palpation to assess for any surface abnormalities. You’ll use the fingertips and the dorsum of the hand for light palpation. Light palpation is used to assess temperature, blood vessels, lymph nodes, and the patient’s thyroid. Deep palpation is used to assess internal organs for masses, size, shape, symmetry, vibration, or tenderness. During deep palpation, you’ll depress the skin one and a half to two inches with firm pressure. Deep palpation is used to assess organs of the abdomen and pelvis. Next is percussion. Percussion involves tapping the fingers or the hand along the patient’s body. Percussion produces sound and vibration.

02:10 Direct percussion involves tapping a body surface with one or two fingers. Indirect percussion involves tapping the distal part of the middle finger, of the non-dominant hand while that non-dominant hand is placed on the body part. Blunt percussion uses a reflex hammer, and this is used to assess reflexes and is also used along the costovertebral angle to assess for any tenderness. The sounds from percussion are tympany which is a drum-like sound produced by percussing over air-filled surfaces. The next sound you may hear is dull. This occurs when you percuss over a solid organ or fluid-filled structures, such as when the patient has ascites. Another sound you may hear is resonance. This is a low-pitched sound found over air-filled tissues such as the lungs. Hyperresonance is a loud, low-pitched sound heard over hyperinflated structures such as lungs that have been affected by emphysema. And finally, flat sounds are found over dense tissues such as muscles or bones. And finally, auscultation. This is listening to various structures with your stethoscope. The diaphragm of the stethoscope is used with firm pressure to listen to high-pitched sounds such as the heart, lungs, and the bowel. You should be able to see the ring of the diaphragm when you remove this from the patient’s skin. The bell of the stethoscope is used for low-pitched sound such as heart murmurs.

03:47 You’ll want to use the bell lightly over the skin surfaces. Thank you.