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