Health Assessment
Basic Concepts
Nagwa Yehya, PhD.
Lecturer Of Critical Care And Emergency Nursing
Faculty of Nursing-Mansoura University
Outlines
• Definition of Physical Assessment
• Purposes of Assessment
• Types of Assessment
• Tools of Assessment
• Methods of Data Collection
• Equipment for Physical Assessment
• Important Aspects of Physical Examination
• Techniques of Physical Examination
Definition of Physical Assessment
➢ It is the process of examining the patient’s body to
determine the presence or absence of physical problems.
➢ Assessment includes systematic Collection, Validation,
Organization, Interpretation, and Documentation of data
for use by health care professionals.
Purposes of Health Assessment
1. Obtain valid information concerning the patient's physical,
psychosocial, and emotional health.
2. Identify health-promoting behaviors as well as actual and/or
potential health problems.
3. Obtain data that will help the nurse establish nursing care.
4. Evaluate the progress of the patient's health problem.
5. Enhance the nurse-patient relationship.
Types of Health Assessment
1. Initial Assessment
It is performed within a specified time on admission.
2. Problem-focused assessment
It is used to determine the status of a specific problem identified in an
earlier assessment. Ex: problem with urination-assess on fluid intake &
urine output hourly.
Types of Health Assessment
3. Emergency assessment; rapid assessment done during any
physiologic crisis of the client to identify life threatening problems. Ex:
assessment of a client’s airway, breathing status & circulation after a
cardiac arrest.
4. Time-lapsed assessment: a reassessment of the client’s functional
health pattern done several months after the initial assessment to
compare the client's current status to baseline data previously obtained.
Types of Health Assessment
5. Comprehensive; Provides baseline data including complete health
history and current needs assessment.
6. Focused; Limited in scope to focus on a particular need or concern
or potential risk.
7. Ongoing; Includes systematic monitoring and observation related to
specific problems.
Tools of Assessment
Assessment can be collected by two kinds of data:
Methods of Data Collection
➢ Interview
➢ Observation
➢ Physical examination techniques
➢ Laboratory and diagnostic test
➢ Consulting other resources
Equipment for Physical Assessment
Stethoscope
Tongue blades
Penlight
Tape measure
Sphygmomanometer
Reflex hammer
Safety pins
Important Aspects of Physical Examination
• Wash your hands, preferably.
• Conducted in head-to-toe order: head ---neck---chest--abdomen---
spine---extremities---anal---genital---nerve system
• Patients tire quickly. The patient should be positioned as
comfortable as possible during the examination.
• When possible, the examining table/bed be situated so that the
examiner has access to both sides of the patient.
Important Aspects of Physical Examination
• An ideal arrangement is to have the table located in the center of
the examination room.
• The patient should be properly draped. Exposing only the areas that
are being examined at that time.
• Stand on the right side of the bed. Exam with one’s right hand.
• When examining a woman’s breasts, it is necessary to check for any
asymmetry by inspecting both breasts at the same time.
Important Aspects of Physical Examination
• The examiner should continue speaking to the patient. Showing care
for his disease and answering patient’s questions.
• It can not only release the patient’s nervousness but also help to
establish a good physician-patient relationship.
Techniques of Physical Examination
I. Inspection
▪ It is the first step in examining a patient or body part.
▪ Method of critical observation used during physical examination.
▪ Inspection is done alone and in combination with other assessment
techniques.
I. Inspection
a. Take time to “observe” with eyes, ears, and nose
b. Use good lighting, preferably sunlight
c. Look at color, shape, symmetry, position, posture, and mental status
d. Odors from skin, breath, wound
e. Develop and use nursing instincts
f. Make sure the room is at a comfortable temperature
g. Look and observe before touching
h. Completely expose the body part you are inspecting while draping the
rest
i. Compare symmetrical body parts
II. Palpation
➢ It is a method of “feeling using the hands during physical
examinations.
As with inspection, the initial step in palpation may be facilitated by
distracting conversation or questions regarding history.
It should be emphasized that during the preliminary stages, muscle
relaxation is the goal.
Ask the patient to flex the thighs.
The degree of muscle rigidity or resistance may be made by light
palpation.
II. Palpation
Always begin palpation in an area of the abdomen that is farthest from
the location of pain.
Light and deep touch
✓ Back of hand to assess skin temperature
✓ Fingers to assess texture, moisture, areas of tenderness Assess size,
shape, and consistency of lesions.
III. Percussion
• A method of “tapping body parts during physical examination with
fingers, hands, or small instruments to evaluate the size, consistency,
borders, and presence of fluid in body organs.
• It is particularly important in examining the chest and abdomen.
• It is used to detect diaphragmatic movement, the size of the heart, the
edge of the liver and spleen, and ascites.
III. Percussion
• Percussion of a body part produces a sound that indicates the type of
tissue within the organ as follows:
✓ Resonant- normal lung.
✓ Hyper resonant- Child’s lung or emphysema.
✓ Tympany- Air-filled organ, e.g., stomach or intestine.
✓ Dull- Dense organ, e.g., liver or spleen.
✓ Flat- No air present, e.g., bone
IV. Auscultation
• Listening to sounds produced by the body
✓ Direct auscultation – sounds are audible without a stethoscope
✓ Indirect auscultation – uses stethoscope
• Warm the diaphragm or bell
• Explain what you’re listening to and answer the patient’s question
promptly.
IV. Auscultation
• Do not apply too much pressure when using the bell
• Do not try to listen through clothing
• Eliminate distracting noises
• Expose the body part you are going to auscultate.
• Describe sound characteristics (frequency, pitch intensity, duration,
quality).