Topics: Physical examination, Palpation, Skin Pages: 6 (841 words) Published: May 16, 2014
Sign of Distress
-Labored breathing
Apparent State of Health
- Acute or Chronically ill
- Frail
Skin Color
- Palor
- Jaundice
Sexual Development
- Facial hair
-Voice change
-Breast development
Weight, by appearance or measurement
Posture and Gait
- sway back
- Lumbar Lordosis

- spastic
- scissors
- prepulsive
- Steppage
- Waddling
Arm and leg on one side (hemiplegic)
General Principles in PE
1) Reflect approach to the patient
- Let the patient know you are a student, and try to appear calm. 2) Decide the scope of examination
-Comprehensive or focused
- How complete should it be? Decide whether to use a comprehensive physical examination (mostly done on new patients or patients admitted to the hospital) 3) Choose the examination sequence
ORDER of assessment:
1. Skin
2. Hair
3. Nails
4. Head
5. Face
6. Ears
7. Eyes
8. Nose
9. Sinuses
10. Mouth
11. Throat
12. Neck
13. breast and Axillae
14. thorax and Back
15. heart and peripheral vessels
16. upper extremities
17. abdomen
18. anus and rectum
19. genitals
20. lower extremities
Major-Body-Systems Approach
individual body systems are appraised, wherein the examiner evaluates one system eg. assessment of the systems
Problem-oriented approach (focused assessment
the nurse assesses the patient as often as it is needed for problems encountered PHYSICAL ASSESSMENT SKILLS
A. Inspection- usint the senses of vision, smell and hearing to observe and dtect any normal condition or any deviations from normal of various body parts Always look before touching
Observe for color, size, location texture, symmetry, odors and sounds USE GOOD LIGHTING

Expose body parts being observed while keeping the rest f the client properly draped B. Palpation- to touch and feel body parts with hands in order to determinet he following characteristics: a) Texture- roughness or smoothness

b) Temperature- warm/cold/hot
c) Moisture- dry/wet/most
d) Mobility- fixed/movable still/vibrating
e) Consistency of structures- soft/hard/solid/fluid filled
f) Strength of pulse- strong/weak/ thread bounding
g) Size- small. Medium large
h) Shape- well defined, irregular
i) Degree of tenderness (through pain response of touch)
Examiner’s fingernails should be short
The most sensitive part of the hand should be used to detect various sensations Light palpation precedes deep palpation
Tender areas are palpated last
Finger tips
Fine tactile discrimination:
Texture size consistency shape

Types of palpation
Light palpation
Little or no depression (less than 1 cm)
Technique to feel for pulses, tenderness, surface skin texture, temperature, and moisture Moderate palpation
Depress the skin surface 1-2 cm (o.5 to 0.75 inch) with your dominant hand, and use a circular motion to feel for easily palpable body organs and masses Note the size, consistency, and mobility of structures you

Deep palpation
Place your dominant hand on the skin surface and your nondoinant hand on top of your dominant hand to apply pressure. This should result in a surface depression between 2.5 and 5cm Bimanual palpation

Use two hand, placing one on each side of the body part being palpated. (eg. Uterus, breasts, spleen)

Involves tapping body parts to produce sound waves. These sound waves or vibrations enable the examiner to assess underlying structures. Percussion has several different assessment uses including:

Eliciting pain: helpts to detect inflamed underlying tissue Determining location, size, and shape:
Determining density: helps to determine whether an underlying structure is filled with air or fluid Detecting abdnormal masses: Detect superficial abnormal...
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