Physical assessment - Overview

A physical assessment is an important nursing skill that is used to collect objective data about a client’s status by using the senses, like seeing a rash or hearing wheezes in the lungs.

A physical assessment can also validate subjective information gathered from a health history, such as a client’s report of pain or dizziness.

Additionally, assessment is the first step in the nursing process, which can be used to develop a plan of care or to evaluate the effectiveness of an intervention.

Let’s review the process of completing a physical assessment.Now, the two most common types of assessments you’ll do as a nurse are a comprehensive assessment and a focused assessment.

A comprehensive assessment, sometimes referred to as a head-to-toe assessment, includes all body systems, and is usually performed during a general wellness visit or when a client is admitted to the hospital or other facility.

This approach is most useful when you want to collect information about your client’s general health status. On the other hand, a focused assessment depends on the situation, and is often based on a client’s presenting symptoms.

For example, if your client has abdominal pain, you’ll focus most of your assessment on their gastrointestinal system. Likewise, if your client is having difficulty breathing, a focused assessment would include their respiratory system as well as skin, vital signs, and level of consciousness.

A focused assessment may also be needed if you are administering certain medications; for example, when you’re administering a cardiotonic medication, you’ll focus your assessment on your client’s heart rate and blood pressure.

Okay, there are a few things to consider before performing a physical assessment. First, check to see if your client requires any precautions in addition to standard precautions such as transmission-based precautions, and don the appropriate personal protective equipment, or PPE.

Then, explain the procedure to your client and be sure to answer any questions they might have before obtaining verbal consent.

If your client refuses any part of the examination, be sure to document this and inform the healthcare provider. Next, provide privacy by closing the door and drawing the curtains.

Promote comfort by ensuring your client is comfortable in the position needed for the exam, adjusting the temperature of the room as needed, ensuring your hands and stethoscope are warm, and offering blankets to help prevent chilling.

Also ensure your client is properly draped during the assessment, and remember to only expose the part of the body that is currently being assessed.

Once you have finished examining an area, make sure to promptly reapply the drape. Now, if you are performing an assessment that might include a sensitive area, like the breasts or genitals, consider requesting a chaperone to be present for the safety of both you and your client.

This is especially important when assessing the opposite sex. Also be sure to explain each step as you conduct the assessment, so your client can anticipate and understand what they are experiencing during the examination.

Finally, remember you’ll need to have adequate light to effectively conduct your physical assessment.The supplies needed for the assessment will vary depending on the type of assessment; however, there are a few supplies you will use often, like a reflex hammer, penlight, measuring tape, washable skin marker, and a stethoscope.

Your stethoscope should have both a diaphragm and a bell, so you can listen for different types of sounds. The diaphragm is used to detect high-frequency sounds, like bowel or lung sounds, while the bell is used to detect low-frequency sounds, like heart sounds.

When using the bell, remember to place it lightly on your client’s skin; if you apply too much pressure, it will function like a diaphragm and will not effectively transmit the low-frequency sounds.

Also, when putting the earpieces into your ears, be sure they are pointed in the same direction as your ear canals, which means they should be pointing towards your nose.

Okay, there are four major methods of assessment: inspection, palpation, percussion, and auscultation. Inspection is performed by visually examining your client.

Inspection begins when you first meet your client, and will continue throughout the examination, as you take note of characteristics like color, size, symmetry, and contour.

Next is palpation, which involves the sense of touch, using your hands and fingers. Palpation can be light or deep, depending on the amount of pressure you apply.

For example, when doing light palpation, you’ll press down about 1 centimeter to assess characteristics like texture, temperature, or pulsations.

With deep palpation, you will apply enough pressure to extend to a depth of about 4 centimeters, so you can assess internal structures for characteristics like size, shape, or mobility.

You can also use two hands to perform bimanual palpation. To do this, the top hand is used to apply pressure, while the bottom hand feels the underlying structures.

This technique is often used when palpating the kidney, and can be useful if your client is obese. Then, there’s percussion which is when you tap the surface of the body in order to produce sounds or vibrations to reveal information about the underlying organs or tissues.

Now, to percuss, you’ll place the middle finger of one hand on the area you wish to percuss, and separate the other fingers away from it.

Then, apply moderate pressure with the middle finger to create a good seal. Don’t let the other fingers rest on your client’s body.

Next, strike the phalanx of the middle finger with the tip of the middle finger of your other hand using a quick, sharp, relaxed wrist motion.

Be sure to keep the striking finger flexed. If you hear a dull sound while percussing over the abdomen, you are likely tapping over a solid organ like the liver.

Likewise, you should expect to hear resonance when percussing over the lungs. Finally, there’s auscultation which involves listening for sounds produced by the body.

For example, you can use a stethoscope to auscultate heart and lung sounds, or you can listen for sounds like respiratory stridor, which often can be heard without the use of a stethoscope.

As the nurse, it’s your responsibility to correctly interpret, report, and document your assessment findings. If your assessment reveals something that’s potentially abnormal or emergent, you should report this immediately to the healthcare provider, while monitoring client progress and changes from baseline.

Alright, as a quick recap… Physical assessment is an important nursing skill that involves performing an examination in order to collect objective data about a client’s condition.

A comprehensive or head-to-toe assessment includes all body systems and is usually performed during a general wellness visit or when a client is admitted to the hospital or other facility.

On the other hand, a focused assessment depends on the situation, and is often based on a client’s presenting symptoms. Before you begin your assessment, explain the procedure to your client and be sure to answer any questions they might have before obtaining verbal consent.

Also institute measures to ensure your client’s comfort and privacy. Some of the common supplies you’ll need include a reflex hammer, penlight, measuring tape, washable skin marker, and a stethoscope.

The four major methods of assessment include inspection, or visually examining your client; palpation, or using the sense of touch; percussion, or tapping the surface of the body to produce sounds or vibrations; and auscultation, or listening for sounds produced by the body.

As the nurse, it’s your responsibility to correctly assess, interpret, report, and document your assessment findings. common supplies you'll need include a reflex hammer penlight measuring tape washable skin marker and a stethoscope The four major methods of assessment include inspection or visually examining your client palpation or using the sense of touch percussion or tapping the surface of the body to produce sounds or vibrations and auscultation or listening for sounds produced by the body As the nurse it's your responsibility to correctly assess interpret report and document your