Chapter 3—
Techniques of
Assessment
and Safety
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© 2019 Wolters
Kluwer Health
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Four
Physical
Assessment
Techniques
Inspection: observing patient
visually for general appearance or
specific details
Palpation: clinical touching of
specific body areas to assess
characteristics
Percussion: tapping technique
with hands to determine condition
of solid or air-filled body areas
Auscultation: using a stethoscope
to assessment movement of air or
fluid within specific body systems
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Hand hygiene
Precautions
to Prevent
Infection #1
• Most important transmission
prevention strategy
• Five sequential steps for
patient-to-patient pathogen
transmission
• WHO recommended
implementation
Glove use
• When to wear gloves
• When to change gloves
• Glove removal
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Standard precautions
Precautions
to Prevent
Infection #2
• Purpose: prevent disease transmission
during contact with nonintact skin,
mucous membranes, body substances,
and bloodborne contacts
• Respiratory hygiene/cough etiquette
strategies
Latex allergy
• Prevention: avoid contact whenever
possible
Skin reactions
• Minimize hand eczema via alcoholbased hand rubs
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Purpose: provides objective physical data leading
to accurate diagnoses and treatment
Consciously observing patients, gathering data
Only technique used for every body part, system
Inspection
#1
Overall observation = general survey
Adequate exposure of each body part is necessary,
maintaining modesty is very important.
Devices may limit visibility: Adjust device to
facilitate complete inspection.
Accurate documentation of findings are important
for communication; are legally binding
Note if data is consistent; identify patterns or
clusters.
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Inspection #2
• Characteristics for inspection
• Physical characteristics; odors
• Behaviors
• Age; gender
• Level of alertness
• Body size, shape
• Skin color
• Hygiene
• Posture
• Level of comfort/anxiety
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Palpation #1
• Purpose: patient physical
assessment using touch for
various characteristics of skin,
other organs
• Texture; temperature;
moisture; size; shape
• Location; position; vibration;
crepitus; tenderness
• Pain; edema
• Finger pads: fine discrimination
• Pulses, small lumps; skin
texture, edema
• Finger palmar surfaces, finger
joints
• Firmness, contour, position,
size, pain, tenderness
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Palpation #2
Hand
Light palpation (1 cm): begin
with
Moderate (1 to 2 cm)
Palm: abdominal assessment
Appropriate for surface characteristics
Assess abdominal organ characteristics
Dorsal surface of hand: temperature
Use pressure from both hands, palmar
surface of fingers.
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Purpose: produce sound or elicit
tenderness
Conducted sounds via
Percussion
#1
• Dense tissue: quiet tones
• Quietest over bones
• Air, fluid: louder tones
• Loudest over lungs, hollow stomach
Direct percussion: Tap fingers directly on
skin
Indirect percussion: Use nondominant
hand as barrier on which to strongly tap
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Percussion tones
• Flat; dull
• Resonant; tympanic
Percussion sounds
Percussion
#2
• Intensity or loudness: volume of
sound
• Pitch or frequency: vibration
oscillation speed
• Duration: length of time sound
lasts
• Quality: subjective description of
sound
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Auscultation #1
• Purpose: listening for body sounds, typically from organs and
tissues, to assess function
• Common foci
• Blood pressure; lungs
• Heart; abdomen
• Descriptors
• Intensity; pitch
• Duration; quality
• Crackles
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Auscultation #2
Stethoscope
Parts
Conducts (does not amplify) sound
Ear tips
Blocks environmental noise
• Differing sizes, firmness
Earpiece: tilted slightly forward
Flexible tubing: 21 to 27 in.
Chest piece: diaphragm, bell (some
varieties)
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Auscultation #3
Stethoscope
Diaphragm
Bell
Light contact to hear lowfrequency sounds
Used for most sounds
Low-pitched sounds
• Heart and lungs
• Heart sounds
Firm contact to hear highfrequency sounds
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Auscultation #4
• Stethoscope
• Disinfect between patients
• Made direct contact with
skin
• Avoid listening over
clothing
• Place the endpiece
between the index and the
middle fingers, not on top
of the stethoscope
• Moisten body hair to avoid
crackly noise as hair and
stethoscope make contact.
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Equipment for a Complete Physical
Assessment
Gather all equipment.
Appropriate equipment depends on the type of
examination.
General assessment: hospital
setting
Vital signs equipment
• Thermometer; alcohol; blood pressure cuff or
machine; watch with second hand; stethoscope
Scale; flashlight
Materials for recording findings
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Documenting Findings
Inspection
Palpation
Percussion
Auscultation
Visualization of general
appearance
Assessing condition via
sense of touch
Tapping to assess
condition of hollow or
fluid-filled spaces
Listening to assess
organ and tissue
condition
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Question #1
• Palpation is the assessment of the patient through touch. What is light
palpation appropriate for?
A. Assessment of the size, shape, and consistency of abdominal organs
B. Assessment of any guarding, grimacing, or tension
C. Assessment of inflamed areas of skin
D. Assessment of 2 to 4 cm below body surface
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Answer to Question #1
• C. Assessment of inflamed areas of skin
Rationale: Light palpation is appropriate for the assessment of surface
characteristics, such as texture, surface lesions or lumps, or inflamed areas of
skin (e.g., over an intravenous site).
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