Physical

Examination
•Binal joshi
•Assistant professor
•Child health nursing
•Manikaka Topawala Institute of Nursing
Definition
•It is the systematic collection of objective
information that is directly observed or is elicited
through Examination Techniques.
 Purposes

To determine the nature

To understand the To determine the cause To understand any
To detect diseases in its of the treatment or
physical and mental and the extent of the changes in the
early stage. nursing care needed for
well being of the clients. disease. condition of diseases.
the client.

To safeguard the client To find out whether the

To contribute to the
and his family by person is medically fit task.
medical research.
noting the early signs. or not for a particular
Techniques of Physical
Examination
The four
basic
techniques Inspection Palpation Percussion
used in
physical
examination
are explained
as follows. Auscultation Manipulation
Inspection
Inspection
•It is the systematic visual examination of the client or it is the process of
performing deliberate purposeful observations in a systematic manner. It involve
observation of the color, shape, size,symetry,position and movements. It also use
the sense of smell to detect odor and sense of hearing to detect sounds.
•General Inspection:
 Overall appearance of health or illness
 Signs of distress
 Facial Expression and Mood
 Body Size
 Grooming and Personal Hygiene
Palpation
 It is use of the hands and fingers to gather information through
touch. It is the assessment technique which uses sense of touch. It is
feeling the body or a part with hands to note the size and position
of the organs.
 The hands and fingers are sensitive tools and can assess
tempareture,turgor,texture,Moisture,Vibrations,Size,Position,
Masses and Fluid.
 The dorsum (Back) surfaces of the hand and fingers are used to
measure temperature.
 The palmar (Front) surfaces of the fingers and finger pads are
used to assess texture, shape,fluid,size,consistency and pulsation.
Vibration is palpated best with the palm of the hand
Percussion
•It is the examination by tapping the
fingers on the body to determine the
condition of the internal organs by the
sounds that are produced. Percussion is
the act of striking one object against
another to produce sound. The sound
waves
• produced
•by the striking action over body tissues
are known as percussion tones or
percussion notes. Percussion is also used
• to
•determine if a structure is air filled,
fluid filled or solid.
 The degree to which sound
propagates is called
Resonance. Percussion
produces characteristic tones
Tympanic, Hyper-resonant,
Percussion Resonant, Dull and Flat.

• Hyper Inflated Lung Tissue:

Hyperresonant
• Normal Lung Tissue: Resonant
• Liver: Dull
• Bone: Flat
Auscultation
 • It is the process of listening to sounds that are
generated within the body. Auscultation is
usually done with a [Link] heart
and blood vessels are auscultated for
circulation of blood, the lungs are auscultated
for moving air (Breath Sound), The abdomen
is auscultated for movement of gastrointestinal
contents (Bowel Sounds)

Auscultation
Four Characteristics of sound are assessed by
auscultation;

Pitch (Ranging from Loudness (Ranging Quality (Gurgling ) Duration (Short,

High to low) from Soft to Loud) Medium or Long)
Manipulation
 It is the moving of a part of the body to
note its flexibility. Limitation of movement
is discovered by this movement.

Manipulation Testing of reflexes

The response of the tissues to external

stimuli is tested by means of a percussion
hammer, safety pin, wisp of cotton or hot
and cold water.
Manipulation
General examination
 Preparation of Environment

Maintenance of Privacy

Role of Nurse in A separate examination room is needed, Keep the door

closed. The relatives are not allowed.

General Lighting

Examination There should be Adequate Lighting.(Natural Lighting)

Comfortable Bed or Examination Table

The client should be placed comfortably throughout

the examination
Preparation of client

Physical Psychological
Preparation of Articles
Articles Purpose
Sphygmomanometer To measure B.P
Stethoscope To listen the Body Sound
Foetoscop To listen the F.H.S
e
T.P.R To assess the vital signs
Tray
Tongue Depressor To examine the mouth and throat
Pharyngeal Retractor To examine the pharynx
Laryngoscope To examine the larynx
Tape Measure To measure height, weight and abdomen circumference
Flash Light To visualize any part
Weighing Machine To check the weight
Ophthalmoscope To examine the inner part of eye ball
Otoscope To examine the ear
Turning Fork To test the
Articles Purpose

Nasal Speculum To examine the Nostrils

Percussion Hammer To test

reflexes

Vaginal Speculum To examine the genitals in women

Proctoscop To examine the rectum

e

Glove To examine the pelvis internally

s

Sterile Specimen Bottles To collect specimen if necessary

 EQUIPMENTS
• STETHOSCOPE
OPHTHALMOSCOPE
OTOSCOPE
SNELLEN CHART
NASAL
SPECULUM
Vaginal
Speculum
Tuning fork
PERCUSSION HARMER
SPHYGMOMANOMETER
General Survey
Neck examination
The examination is carried out in an orderly manner
focusing upon one area of the body at a time.

• General Appearance
• Nourishment : Well Nourished or Under
• Body Built Nourished
• Health : Thin or Obese
• Activity : Healthy or Unhealthy
Mental Status : Active or Dull (tired)
Consciousness: Conscious,Unconsious,Delirious,Talking,Incoherently
Look : anxious or worried, depressed etc..
Posture

Body Curves: Lordosis,Kyphosis,scoliosis Movement: Any

limp.
Height and Weight

Skin Conditions

Colour : Pallor,Jaundice,Cyanosis,Flushing etc…

Texture : Dryness,Flaking,Wrinkling or Excessive moisture.

Temperature ; Warm, Cold and Clammy

Lesions : Macules,Papules,vesicles,wound etc…

 Shape of the Skull and Fontanels (newborns) Skull
Shape Circumference

Head and Scalp Scalp: Cleanliness, Condition of Hair,dandruff,Pediculi or

Infection.
Face

Face:Pale,Flushed,Puffiness,Fatigue,Pain,Fear,Anxiety,
Face Enlargement of Perotid Glands etc…
Eyes
• Eyebrows : Normal or Absent
• Eye lashes : Infection, Sty
• Eye lids : Oedema,Lesions,Ectropion (eversion), Entropion(inversion)
• Eye balls: Sunken or Protruded
• Conjuctiva: Pale,[Link]
• Sclera : Jaundiced
• Cornea and iris : Irregularities and abrasions
• Pupils : Dilated,Constricted,Reaction to light
• Lens: Opaque or Transparent
Eye
Fundus: Congestion,Hemorrahagic Spots.

Eye Muscles : Strabismus (Squint)

Vision: Normal Myopia (Short Sight),Hyperopia (Long

sight)
Ears:

External Ear : Discharges, Cerumen, Obstructing the ear

Passage.
Tympanic Membrane: Perforations,Lesions,Bulging.

Hearing : Hearing Aquity

 Nose:

External Nares: Crusts or Discharges

Nostrils: Inflammation of the Mucus

Membrane,Septal Deviations.

Cont.. Mouth and Pharynx:

• Lips : Redness,Swelling,Crusts,Cyanosis,stomatitis.
• Odour of the mouth : Foul Smelling
• Teeth : Discoloration and dental caries
• Mucus Membrane : Ulceration and Bleeding, swelling.
• Tongue: Pale,Dry,Lesions etc…
• Throat and Pharynx : Enlarged Tonsils,Redness,Pus.
Assess the neck
 Examination of the neck includes
inspection for any

scars, masses, glandular or nodal

enlargement.

Inspection
Inspect the trachea, noting any deviation.

Next inspect the thyroid gland as the

patient swallows, noting any
enlargement
 Evaluate by palpation the lymphatic chains as well as the
presence of any masses in the neck.

When evaluating lymph nodes for pathology, note their size,

shape, consistency, mobility, and tenderness.

Note if only one region has enlarged lymph nodes or if all nodes

Palpation are enlarged. It is easy to mistake a band of muscle for a lymph

node just as it is easy to miss abnormally enlarged lymph nodes
if a careful exam is not performed.

A lymph node can be rolled from side to side and up and down
whereas a band of muscle cannot.

Palpate the thyroid gland noting size, shape, consistency as well

as presence of any nodules.
PALPATE TRACHEA
AND LYMPH NODES
Palpate the
thyroid gland
Assess the thorax and
lungs
Introduction

The traditional systematic

approach involves inspection,
Thorough evaluation of
followed by palpation,
the thorax and lungs is an
percussion and then
essential component of a
auscultation of both the
complete physical examination.
anterior, lateral, and
posterior thorax.
 Clubbing.

Obvious stridor, or wheezing during the interview.

Facial cyanosis or flushing.

Inspection Prolongation of the expiratory phase.

Position of the trachea.

Shape of the chest.

Note also the rate of breathing, the depth of breathing,

and if breathing is labored.
Palpation
 Is used to evaluate the symmetry and extent of
thoracic movement during inspiration.

Is usually symmetrical and is at least 2.5 centimeters

between full expiration and full inspiration.

Thoracic
expansion: Can be symmetrically diminished in ankylosing
spondylitis.

Can be unilaterally diminished in chronic fibrotic lung

disease, extensive lobar pneumonia, large pleural
effusions, bronchial obstruction and other disease
states.
Auscultation
 During auscultation:

Have the patient sit upright if possible, breathing slowly and deeply
through an open mouth.

Use the diaphragm of the stethoscope, placed firmly and directly on

the skin. The presence of chest hair may require firmer pressure to
eliminate any potential interference.
Auscultate all areas systematically including
anterior, posterior, and lateral lung fields.

Compare sounds heard on one side to sounds

heard in the same location on the opposite
side. Compare sounds in the apices to
sounds in the bases.
During auscultation:

Listen to inspiration and

expiration in each location.
Lung sounds may be louder in
When abnormalities are found, Note the inspiratory to
areas where lung tissue is
listening to several breaths in expiratory ratio.
more dense.
that location may be
necessary.

Lung sounds may be

diminished due to shallow
Lung sounds are absent over
breathing or hyperinflation,
a pneumothorax.
pleural disease, mucous
plugging or obesity.
Abnormal findings

• :increase in chest size and contour , abnormal breathing pattern with

the use of accessory muscles, unequal chest expansion, and abnormal
breath sounds, barrel chest, pigeon chest
• Abnormal or adventitious breath sounds may
indicate the presence of pathology and are
generally divided into two categories: discontinuous
and continuous sounds.
• Discontinuous adventitious breath sounds
include crackles (also called rales). Continuous
sounds include ronchi and wheezes.
• When describing adventitious sounds, the timing of
these sounds in the respiratory cycle should be
noted (e.g. "late inspiratory crackles" or "inspiratory
and expiratory wheezes") as well as their location,
and whether they clear with coughing or not.
Percussion

• Percussion is the act of tapping on a

surface, thereby setting the underlying
structures in motion, creating a sound and
palpable vibration. Percussion is used to
determine whether underlying structures are
fluid-filled, gas-filled, or solid. Percussion:
ASSESSING THE BREAST AND
AXILLA
Assessment of Abdoman
Areas of Abdoman
Inspection

• looks at the surface, outline, and movements of the abdomen

• looking for anything abnormal like scars, stretch marks, lesions,
dilated veins, or rashes.
•  determines the shape of your abdomen, looking for any
bumps, abdominal distension, or depressions. The doctor will
also check your belly button for abnormalities like a hernia.
Palpation
• On light palpation, the examiner tests for any palpable mass,
rigidity, or pain on the surface.
• On deep palpation, the examiner is testing for any 
organomegaly (enlarged organs.) Typically, the clinician is
looking for enlargement of the liver and spleen or abnormal
masses in the intestines. Sometimes the physician looks for the
kidney and uterus as well
Percussion
Auscultation of Abdoman
•Auscultation : Bowel sound and FHS
•Palpation : Liver margin, Palpable spleen, tenderness at the abdomen
•Percussion : Presence of Gas, Fluid or Masses.
Extremities
 Movement of joints,
Tremors,
Extrimities Clubbing of fingers,
Varicose vein,
Reflexes etc…
Genitalia
 Inguinal lymph glands : Enlarged,
Palpable.
Patency of Urinary meatus and rectum.
Descent of the testes
Vaginal discharges
Genital
Presence of STD Hemorrhoids

Enlargement of Prostate Gland

Male Genitalia

• Inspect and palpate the penis

• 1) Inspect the skin, glans, and urethral meatus
• 2) If you note urethral discharge, collect a smear for microscopic
examination and a culture
• 3) Palpate the shaft of penis between your thumb and first two fingers
Male genitals
Inspect and palpate the scrotum

• 1) Inspect the scrotum

• 2) Palpate gently each scrotal half between your thumb and first two
fingers
Female
Genitals
Female genitals For inspection of female genitals

• Place the client in the supine position with the knee flexed and feet
resting on the examination table.
• External genitalia Inspection
• 1)Note skin colour, hair distribution, labia majora, any lesions, clitoris,
labia minora, urethral opening, vaginal opening, perineum, and anus.
• 2) Look for any discharge or bleeding, prolapse, from the vagina
Back
Neurological test
COORDINATION EQUILIBRIUM REFLEXES TEST FOR
TESTS TESTS SENSATIONS
 Ask Ask the client to close the eyes

Select Select areas on face , arms, hands, legs and feet

For
sensation Give a superficial pain, light touch and vibration to
Give each site by turn

Note Note the client’s ability of sensation on each site

Test for Cranial nerves Cranial nerve I

2) Ask him/her the source

of smell using familiar,
: Olfactory nerve (✽To test 1)Ask the client to close conveniently obtainable,
the sense of smell ) his/her eyes and non-noxious smell
such as coffee or tooth
paste
Test stereognosis

Ask Ask the client to close his/ her eyes 2

Place Place a familiar object(i.g., clip, key or coin) in the client’s hand

Ask Ask the client to identify it

Test for the cerebellar function

Test for the Use finger-to- nose

cerebellar function test or rapid-
of the upper altering –
extremities movement test
Test for the cerebellar function of the lower
extremities
Test for the cerebellar function of the lower extremities

1) Ask the client to reach heel down the opposite shin or

2) Ask the client to stand and walk across the room in his/her
regular walk back ward, and then turn toward you
Triceps reflex(C7 to C8)

Tell the client to let the arm “just go dead” as you suspend it by
Tell holding the upper arm

Strike Strike the triceps tendon directly just above the elbow

Observe Observe the response

Brachioradialis reflex(C5 to C6)

1) HOLD THE CLIENT’S THUMB TO 2) STRIKE THE FOREARM 3) OBSERVE THE RESPONSE
SUSPEND THE FOREARMS IN DIRECTLY, ABOUT 2 TO 3 CM
RELAXATION ABOVE THE RADIAL STYLOID
PROCESS
Deep tendon reflex
(✽To elicit the intactness of the arc at specific spinal level)
Biceps reflex(C5 to C6)

1) Support the client’s forearm on yours

2) Place your thumb on the biceps tendon and strike a blow on

your thumb

3) Observe the response

Quadriceps reflex(“Knee jerk”) (L2 to L4)

1 2 3
1) Let the lower 2) Strike the tendon 3) Observe the
legs dangle freely directly just below response and
to flex the knee the patella palpate contraction
stretch the tendons of the quadriceps
 1) Position the client
with the knee flexed 2) Hold the foot in
and hip externally dorsiflexion
Achilles rotated
reflex(“Ankle
jerk”) (L5 to
S2)
3) Strike the Achilles
4) Feel the response
tendon directly
 Position Position the thigh in slight external rotation

Superficial
reflex With the reflex hammer, draw a light stroke up the
Planter Draw lateral side of the sole of the foot and inward across
the ball of the foot
reflex (L4 to
S2)
Observe Observe the response
Thank you …