2. Objective data
• Data directly observed by the examiner
Maria Carmela L .Domocmat, RN, MSN
3. Objective data
• Data include:
– physical characteristics (skin color, posture)
– body functions (HR, RR)
– appearance (dress, hygiene)
– behavior (mood, affect)
– measurement
• (BP, Temp, Ht, Wt)
– results of laboratory testing
• (platelet count, CXR)
Maria Carmela L .Domocmat, RN, MSN
4. Requires basic knowledge in:
1. Types of and operation needed for the
particular examination
2. Preparation of the setting, oneself, and
the client for the PA
– Setting
– Self
– Client
Maria Carmela L .Domocmat, RN, MSN
5. 3. Performance of the four assessment
techniques: IPPA
Maria Carmela L .Domocmat, RN, MSN
6. Equipments for Physical
Assessment
• Assessment document forms
• Coin or key
• Cotton ball
• Cover card (for eye assessment)
• Gloves
• Goniometer
• Gown for client
• Lubricating jelly
Maria Carmela L .Domocmat, RN, MSN
7. Equipments for Physical
Assessment
• Magnifying glass
• Marking pencil
• Mini-mental status Exam (MMSE) form
• Newspaper print or rosenbaum pocket
screener
• Notepad and pencil
• Ophthalmoscope
• Otoscope
Maria Carmela L .Domocmat, RN, MSN
8. Equipments for Physical
Assessment
• Paper clip
• Penlight
• Pillows (two small pillows)
• Platform scale with height attachment
• Reflex hammer
• Ruler with centimeter markings
• Skin-fold caliber
• Flexible tape measure
Maria Carmela L .Domocmat, RN, MSN
9. Equipments for Physical
Assessment
• Small cup of water to drink
• Snellen chart
• Stethoscope with sphygmomanometer
• Substances for testing taste (e.g. salt,
calamansi or lemon, sugar)
• Substances for testing smell (e.g. soap,
coffee)
• Thermometer
Maria Carmela L .Domocmat, RN, MSN
10. Equipments for Physical
Assessment
• Tongue depressor
• Tuning fork
• Vaginal speculum
• Watch with second hand
Maria Carmela L .Domocmat, RN, MSN
20. Inspection
• Involves using the sense of vision, smell,
and hearing to observe and detect any
normal or abnormal findings.
Maria Carmela L .Domocmat, RN, MSN
22. Inspection
• Precedes the PPA because the latter
techniques can potentially alter the
appearance of what is being inspected
Maria Carmela L .Domocmat, RN, MSN
23. • Note the following:
– Color, patterns, symmetry, size, location,
consistency, movement, behavior, odors, or
sounds
Maria Carmela L .Domocmat, RN, MSN
25. Palpation
• Involves using parts of the hand to touch
and feel for the following characteristics:
• Texture – rough or smooth
• Temperature – warm or cold
• Moisture – dry or wet
• Mobility –fixed, movable, still, vibrating
• Consistency – soft, hard, fluid-filled
• Size – small, medium, large
• Shape –well defined, irregular
• Degree of tenderness
Maria Carmela L .Domocmat, RN, MSN
27. Parts of hands used
– Fingerpads – fine discriminations, pulses,
texture, size, consistency, shape, crepitus
– ulnar/palmar surface – vibrations, thrills,
fremitus
– dorsal surface -temperature
Maria Carmela L .Domocmat, RN, MSN
28. • Crepitus is a symptom characterized by a crackling or grating feeling
or sound under the skin, around the lungs or in the joints. In soft
tissues, crepitus is often due to gas, most often air, that has
abnormally penetrated and infiltrated an area (for example, in the
soft tissues beneath the skin).
• In a joint, crepitus can indicate cartilage wear in the joint space. The
term "crepitus" is derived from the Latin, meaning "a crackling sound
or rattle." Typically, crepitus is a grinding noise coupled with a
sensation in the affected joint. Crepitus can occur with or without
pain.
Maria Carmela L .Domocmat, RN, MSN
30. Light palpation
• very little or no pressure
(less than 1 cm)
• feel the structure using a
circular motion
• use: feel pulses,
tenderness, surface skin
texture, temperature,
moisture
Maria Carmela L .Domocmat, RN, MSN
32. Moderate palpation
• Depress the skin surface 1 to 2 cm
• size, consistency, mobility
Maria Carmela L .Domocmat, RN, MSN
33. Deep palpation
• Place dominant hand on the skin surface
and nondominant hand on top of the
dominant hand to apply pressure (2.5-5
cm or 1 to 2 inches)
Maria Carmela L .Domocmat, RN, MSN
34. • Feel very deep
organs or structures
that are covered with
thick muscles
Maria Carmela L .Domocmat, RN, MSN
35. Bimanual palpation
• Use two hands, placing one on each side
of the body part (uterus, breasts, spleen)
being palpated
• One hand apply pressure, other hand feel
structure
• size, shape, consistency, mobility
Maria Carmela L .Domocmat, RN, MSN
39. Percussion
• Involves tapping the body parts to produce
sound waves
• The sound waves or vibrations enable the
examiner to assess the underlying
structures.
Maria Carmela L .Domocmat, RN, MSN
40. Percussion
• Uses:
– Determining location, size, and shape
– Determining density
– Detecting abnormal masses
– Eliciting pain
– Eliciting reflexes
Maria Carmela L .Domocmat, RN, MSN
44. Percussion Sounds
• Resonance:
– heard over part air and part solid
– normal lung
– loud intensity, low pitch, long (length), hollow
(quality)
Maria Carmela L .Domocmat, RN, MSN
45. Percussion
• Dullness: over more solid organs
(diaphragm, liver)
– Medium ,medium, moderate, thudlike
• Flatness : over very dense tissue (muscle,
bones, sternum, thigh)
– Soft, high, short, flat
Maria Carmela L .Domocmat, RN, MSN
46. • Tympany: heard over air
– Puffed out cheek, gastric bubble
– Loud, high, moderate, drumlike
• Hyper resonance: heard over mostly air
– Lung with emphysema
– Very loud, low, long, booming
Maria Carmela L .Domocmat, RN, MSN
48. Auscultation
• Listening to sounds produced by the body
(heart, lungs, blood vessels, abdomen)
• Stethoscope: does not magnify sound but
does block out extraneous room sounds
Maria Carmela L .Domocmat, RN, MSN
51. Auscultation
• Diaphragm: high-pitched sound
– Normal heart sounds, breath sounds, bowel
sounds
– Hold the diaphragm firmly against the
person’s skin –
– firm enough to leave a
slight ring afterward
Maria Carmela L .Domocmat, RN, MSN
52. Auscultation
• Bell: low-pitched sounds
– abnormal heart sounds and bruit (abnormal
loud, blowing, or murmuring sounds)
– FHT
– Hold lightly against the person’s skin – just
enough that it forms a perfect seal; any harder
causes the skin to act as a diaphragm,
obliterating the low-pitched sounds
Maria Carmela L .Domocmat, RN, MSN
53. Factors to consider
• Eliminate any confusing artifacts
Maria Carmela L .Domocmat, RN, MSN
54. Eliminate any confusing artifacts
• Room must be quiet
• Keep examination room warm
• Clean the stethoscope endpiece with an
alcohol wipe. Then warm it by rubbing it in
your palm: this avoids the “chandelier
sign” elicited when placing a cold endpiece
on a warm chest
Maria Carmela L .Domocmat, RN, MSN
55. Eliminate any confusing artifacts
• Wet the hair before auscultating the hairy
chest: The friction on the endpiece from a
man’s hairy chest causes a crackling
sound that mimic an abnormal breath
sound called crackles.
• Never listen through a gown: reach under
a gown to listen, but take care that no
clothing rubs on the stethoscope
Maria Carmela L .Domocmat, RN, MSN
56. Factors to consider
• Eliminate any confusing artifacts
• Listen selectively: only one thing at a time.
• As you listen, ask yourself:
– What am I actually hearing?
– What should I be hearing at this spot?
Maria Carmela L .Domocmat, RN, MSN