Examination Techniques

A physical assessment involves using examination techniques to collect data about a patient's health, and includes inspection, palpation, percussion, and auscultation.

Inspection involves visually assessing your patient. It begins when you first see your patient and continues throughout the examination. These initial observations can include their general demeanor, facial expression, gait, and how they answer your questions. Your findings during your initial inspection can affect how you approach the rest of your exam; for example, if you notice your patient is guarding their stomach, you'll likely start with an abdominal assessment. In addition to your visual assessment, use your sense of smell to alert you to issues such as a strong body odor or a foul-smelling discharge from a wound.

Palpation is where you'll use touch to assess texture, temperature, moisture, pulsations, organ location and size, as well as the presence of swelling, lumps, and pain. You'll use light palpation to detect superficial problems, like the presence of tenderness or changes in skin texture; followed by deeper palpation for determining the characteristics of organs and masses. Keep in mind that with deep palpation you should apply intermittent pressure and stop if your patient experiences pain.

Now, depending on what aspect you're assessing, you'll use different parts of your hands during palpation. For example, the pads of your fingers are best suited to feel skin texture, swelling, pulsation, and masses; the dorsal, or back side of your hand, is most sensitive to temperature, so it can be used to feel heat and cold; and the ulnar surface, or side of the hand closest to the pinky fingers, can be used to detect vibrations.

Percussion involves tapping on the surface of your patient's skin with short, sharp strokes to produce sounds or vibrations, which can help determine the size, shape, and density of body tissue. Percussion can be direct, where you'll percuss directly on your patient's skin with your hand or finger; or indirect, where you'll place the pads of your non-dominant hand's middle finger directly on your patient and use the tip of your dominant hand's middle finger to strike your non-dominant hand's middle finger, just behind the nail bed.

The various body tissues and structures will produce different sounds when percussed, because they differ in composition and density. Resonant sounds are low-pitched and clear and can be heard over air-filled structures like the lungs; while hyper-resonant sounds are lower in pitch but more booming because of air trapping and hyperinflation in the lungs from conditions like emphysema. Tympany is a high-pitched drum-like sound heard over air-filled organs like the stomach. Dull sounds are high-pitched thuds that can be heard over solid organs like the liver. Lastly, flat sounds are high-pitched and shorter in duration than dull sounds and can be heard over structures like bones, muscles, or tumors.

Finally, there's auscultation, where you'll use a stethoscope to listen to sounds produced by the body. Now, a stethoscope includes two end pieces, a diaphragm and bell. The diaphragm is used to hear high pitched sounds, like breath or bowel sounds. On the other hand, the bell, or the smaller, concave side, is used for soft, low-pitched sounds, like extra heart sounds or murmurs.

Prior to auscultation, try to get rid of potential artifacts, which are environmental sounds that can affect what you hear through the stethoscope. These can be caused by noises in the room, body hair, or touching the tubing on the stethoscope. To eliminate artifacts, perform auscultation in a quiet setting and be sure to place the diaphragm or bell directly on your patient's skin instead of auscultating through clothing.

Alright, as a quick recap... A physical assessment involves using examination techniques to collect data about a patient's health, and includes inspection, palpation, percussion, and auscultation.