PHYSICAL
ASSESSMENT (IPPA)
INSPECTION
• It is the process of observation. The nurse
inspects the body parts to detect normal
characteristics or significant physical
signs.
• It helps to know normal physical
characteristics before trying to
distinguish abnormal findings.
Principles to use INSPECTION
effectively:
• Good lighting
• Position and expose body parts so that all surfaces
can be viewed.
• Inspect each area for size, shape, color, symmetry,
position and abnormalities.
• Compare each area inspected with the same area
on the opposite side of the body.
• Additional light to inspect body cavities.
• Do not hurry inspection. Pay attention to detail.
PALPATION
• Further assessment of body parts
is made through sense of touch.
Through PALPATION , hands can
make specific measurements of
physical signs, resistance,
resilience, roughness, texture and
mobility.
STEPS:
[Link] should be relaxed and positioned
comfortably.
[Link] the client to take slow, deep breaths
enhances muscle relaxation.
[Link] the arms of the client along the side
of the body thus decreasing abdominal
rigidity.
* Clients appreciate warm hands, short
finger nails , gentle touch.
• Palmar, finger pads – sensitive parts
of the hand. It is used to assess
position, texture, size, consistency,
form of a mass, pulsations.
• Dorsum or back of the hands- is used
to assess body temperature.
• Palm, ulnar surface – sensitive to
vibration.
PERCUSSION
• Tapping the body with fingertips to
evaluate size, borders, consistency of
body organs, fluid in body cavities.
• Involves striking one object against
another, thus producing vibration
and sound waves.
• When the examiner strikes the
body’s surface with a finger,
vibration is transmitted through
the body tissues. An abnormal
sound suggests a mass or
substance such as air, fluid
within an organ or body cavity.
TWO METHODS OF PERCUSSION
1. DIRECT – striking the body surface
directly with one or two fingers.
2. INDIRECT- place the middle finger of
the non –dominant hand( PLEXIMETER)
firmly against the body surface keeping
the palm and remaining fingers off the
skin. Tip of the finger ( plexor) strikes
the distal point of the pleximeter.
• Examiner uses a quick, sharp stroke
with the plexor finger, keeping the fore
arm stationary. The wrist remains
relaxed to deliver proper blow.
TYPES OF SOUNDS:
[Link]
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TYPES OF SOUNDS:
[Link]- high pitched, drum-like ( normal lung
tissue).
2. Hyperresonance- loud, booming sound ,
( hyperinflated lung as in clients with
emphysema).
3. Dullness- soft , high pitched , thudlike sound
( heared over dense organs such as liver and
heart.
4. Flatness- soft, high pitched sound ( heared over
bones, muscles and tumors).
AUSCULTATION
• Listening to sounds produced by the
body.
• Carried out last.
• Important to first learn the normal
sounds created by the cardivascular,
respiratory and gastrointestinal systems
such as the passage of blood through an
artery.
• To auscultate correctly the nurse needs:
[Link] hearing acuity
[Link] stethoscope
[Link] of how to use the stethoscope.
[Link] should always be placed on
naked skin.
[Link] is best for low pitch sounds( heart
sounds).
[Link] is best for high pitch
sounds( bronchial sounds.)
